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t ' <br /> SAN IcAGUIN CCUNT..' ELIC SEALTH SERVICES/ENVIRONMENTAL HEALTH <br /> UG: ttS8EET FOR SITE CLOSURE EVALUATION A DATE �)-7� y�� <br /> .A.ME 'OF FACILITY �( ^�s GCc SO�i� SVEEPS' <br /> A00RfSSI TAMC IDN <br /> TANK SIZEI 10 ,,ao� FUEL TYPE /,-. <br /> I. GEVERAL SITE HISTORY <br /> •*r <br /> IS permit current? Yes No / Permit - Facility Status Code �rj Dae.Soil/GW Cont Yes No <br /> Number of Tanks at facility Age of Tanks(if available) u Type of Tank Steel Fbrgl Sngl Dual <br /> til. TAMC HISTORY <br /> Was Tank test ed? Yes No Failed precision :est T res He If yes, give date(s) <br /> Was a repair made to the tank system? Yes Me If yes, what Hes repaired? <br /> Was repair done under inspection? Yes No IYore soil samples analyzed? Yes INoI aTXE TPH-G TPH-D Pb/EDB <br /> l; <br /> Type of failure/discharge catastrophic fang-tern leakage overfill ur+lrt+o++n ether: <br /> IV. RE140VAL HISTORY (ATTACH INSPECT REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Smit Samples Received Yes a Depth to Ground Vater 35 r Rif/Year/'q'fb ; Average ArnAL Precipitation A- 14 10-25 <br /> 0n-Site Welts) Yes No Nurber & Type Irr Dom Pub <br /> 5 Score S Score S Score <br /> Distance to Wells) from Tank &✓� ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition. R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is mat <br /> Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 T 25-50\1 <br /> Fractures in subsurface Capplies to foothills or mountain areas) None Unknown Present <br /> Average Art-mat Precipitation (inches) xxxx= <to 9 10-25 =xxxxx 26-40\2 <br /> )Han-Nader conduits which increase vertical migration None uri=mn Present <br /> of leachate (i.e., septic systems, water wells, ponds) <br /> Unique site features: Recharge area, coarse soil, nearby wells. At least !tore than <br /> Xxxxxx None 9 one one <br /> COLUMN TOTALS3-2-TOTAL POINTS <br /> Sample Result: (a T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> X9 T X E 8 JT X E <br /> AMI" ALLOWBLE 3-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NAt3 <br /> Sample Result: GASOLINE 1000 100 . t0 <br /> MAXIMUM ALLOWSLE TP8 LEVELS.{PPM} <br /> C�- M TPH CT DIESEL 10,000 1000 MCI <br /> FOOTNOTES: *"If documented sail and/or you d water contamination is present, do not complete the teaching potential <br /> analysis. Cf.*., site is currently on UGI Contamination List far soil or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. it depth —S ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for STX&E are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel)- <br /> VI. STAFF RECO14MENDATION/CONCLUSION Pp'^ <br /> 1. Are 3TX b E or TPN Concentrations > Allowable Levels *Yes Na <br /> 2. Recommend Site Ctosure Yes IM01 If Yes, Refer to Site Mitigation for Evaluation 4- 0 LSF T <br /> VII. REVIEW EVALUATION - TO 36 COMPLETED SY A SUP£RVI=SENIOR p r P+lc <br /> CONCUR WITH STAFF RECCWENDATION FOR CLOSM_-jTES NO REFERRED JO SITE MITIGATION FOR EVALUATION YES NO <br /> I. <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 30 (UGTbKSHT)\5/90 <br /> .I J <br />