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SAN xAllU NTY PUBLIC !TEAL k SMl=-S/E?lV[RUHMWALOTH 0MUCH <br /> UGST JQRKSHEET FOR SITE C`SME EVALUATION/ CATEI <br /> O <br /> ;NAME OF FACILITY <br /> IADDRE55� P Dit <br /> ITANK fa �J / p+ Q <br /> TANK SIS I ' Ol hi1Ei <br /> a <br /> :I. G-cNNEZAL SITE HISTCRY k <br /> i <br /> I(s permit current?IYes IN* IPermit *I Faeili ` <br /> ty latus ,`tel IOac,Soil/GLI CaretlYesl IHoI <br /> Nunoer of Tanks at r'aciEityl <br /> Age of Tanks(if avaiEaote)I�kjIType sr TanklSteeE FbrgEl ISng! Ouall <br /> (I!. TANK HISTORY <br /> I �} <br /> E <br /> F Vas Tank cested7lYesl No JFaiEed precision cos; ?Iyes 40I` give date(s)I" <br /> Was a re--,a i r ,mde to ttte tank system?i Yes I No If yes, uhat -as cepa i re v / <br /> 3 <br /> leas repair done under insoection7lYesl IMCI lVere sail samotes analyzedlf7esI l gal EITXEI TPff-Ol, l TAH 3' l <br /> ` Pb/E78 <br /> Type of failure/discharseI lcatastrat:hicI ILong-cent teakagel averfiEll Iwkna4iI�Iother: I <br /> IV. ,ReICVAL HISTORY (ATTAM INSPECMN REPORT FOR SITE DETAILS/GM-12C7 DATA R21LUC31k ?OTEATIAL ANALYSIS) <br /> (snit Sa=les :4eceivedlYesl INoi IDeptte to Ground Vaterl��(��Ref/Yearl��j I,; I!Avemge ArnuaL PreeipitatianlA=114 Ito-25 <br /> Iart-size uetL(s)IYesl IHoI Moaner & Type! IIrrI IDoar IPvaI 1I <br /> S !Scare S Scare S Scare <br /> tlistanc_ co 'lell(s) frau rank C j10 pts C 9 its C 5 pts <br /> 0 'if O if 0 if <br /> a cwxlit!an R condition R Condition <br /> I . Site Feature - Leac:ting PiAnalysis = lis .met = is met _ is Met <br /> IMinimmt Depth :a grouredwater Frees she Sail 5arreale (feet) I5t-iQ0 I ! ?5-50\1 <br /> jFrac..jres in subsurface Cacplies to Foothills or-,a wcain areas) I i D Ilene I I�Unkno+in„�• Ipresent <br /> IAverage Annual Precipitation (inrweesJ I:aoc�cxl;,ct0 I 9 I i0-M Ixxxx= 25-401,2 I <br /> :of <br /> conduits whir-t incrrese vertical migration <br /> of Leachate C i.a., septic s"rew, +ater wells, pertds) lane 11 Unkrsa+n IP ..st <br /> Unique site features: Recharge area, parse sail, nearby weLLs_ At Leah More than <br /> � one <br /> C:LtDiN TOTALA>yTOTRI POINTS <br /> Satemle Result: CS T X OR ?) RANGE OF 'gTAL POINTS 49 pts Or mare;! 44 pts or less <br /> 3 <br /> dLAXI] M ALLDWLBL 3-i-X-3 L-EVELS (FM) 1 50 :j 5a 50 a' 3 t. i. NA\3 <br /> r <br /> 5 !e Result: GASOLINE 10� I I iDZY II 10 I <br /> r <br /> E r->f.3 G'/ IUXD M ALLDi1AKE TP% O=VELS (PPN) fs <br /> K E TPff DtESF_ to,oao � � tQ0O � too <br /> FCOTNOTES: w&JTrf documenced soil and/or ground Inver contamination is present, do not complete a Leaching potentiaL <br /> anaEysis- (i.e., site is aurettLy an UGT'CaTcninac'ion List for soil or graiatd water.] <br /> \1 If dwd is > 5 ft. and < a ft-, score 0 paints. if depw 1-5 ft., do not use cable- <br /> \2 If precipitation is ;, 40 inches, spry 0 paints- <br /> \3 Levels for 3TX&E are rent applicabte at a TFR rion,l f 10 ppa (gasatine) or 100 ppm Wiese(). <br /> VI• STAFF RECCMFiENDATION/C XCLUSIGI <br /> t. Are 3TX & = or TPH C.x>ceriiracions > Attoweote Levets I_Yes Ha <br /> 2. 4econmur <br /> ertd sire CLos +_I7esl IHoI Iy'tf Yes, Refer to Site Nftigatsors ',fin- 5valuation <br /> VII. IEVIEEW :VALUATICH - TO 3E CI=TED ST A SUPERVISOR/SMICR P M <br /> =%=CUR tV 1TH STAFF RECCWe0ATrGX FOR CLOSURE i YES 1 I ND i -.0 SIT.- :ETI cATIOH FOR =-IALlL17I01I l YES 1 l NQ l I <br /> DATE REFS RED 1 I DATE CLOSURE LE-TTER MAILr'Z� I <br /> NAME CF k 9 ,, <br /> EVALUATOR �p <br /> E?! 23 3Q (UGTVKSNT)\5/90 <br /> i� 'Il <br />