Laserfiche WebLink
• ...� nQPA to w►• .l►un <br /> UQ' •QRKSMEET FOR SITE CLOSURE EVALUATION DATE <br /> NAME OF FACILITY CODE <br /> ADDRESS <br /> TAU ID if O Z <br /> TAM SIZE S, Fr-,o FUEL TYPE <br /> Il. GENERAL SITE HIsTORY <br /> Is permit current? Yes No Penia 0 - facility Status Code Doc-Soft/GW Cont Yes Mo <br /> Number of Tanks at facility Age of Tanks(if avaitabte) Type of Tank Steel Fbrgt Sngl Oust <br /> Ill. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision testi Yes No if yes, give dates) <br /> Use a repair auk to the tank systsW lyes No if yes, what was repaired? <br /> Was repair done under inspectiW Yes No Were soil samptes analyzedT Yes No sTXE TPN•G TPN-0 ft/M7ur <br /> Type of faile/dfscharge catastrophic tang-ten leakage overfill unknown other: <br /> lV. REMOVAL HISTORY (ATTACS INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soft Samples Received Yes No Oepth to Grand Water Ref/Year I r[,> ; Average Annul Precipitation As 14 10-25 <br /> On-Site Yett(s) YesNo I Number i Type Err Oam Pub <br /> wre <br /> S es scow. S score <br /> Ofstance to Wett(s) frac Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 it 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 not <br /> Minimus Depth to grardmweter from the soft Sample (feet) z� 3,100 51-100 2540\1 <br /> Fractures in subsurface (applies to foothitts or mountain areas) None Unknown Present <br /> Average Annual Precipitation (in:lus) xxxxxx <10 9 10-25 xxKx)aok 26-40\2 <br /> Man-Made conduits which fncrage vertical migration <br /> of teschate (i.e., septic systems, water wells, ponds) Mone Unknown -67 Present <br /> Unique site features: Recharge ares, coarse soil, nearby watts. q At least More than <br /> xxxxxx None t one ane <br /> - <br /> COLt= TOTALA»TOTAL POEM + • s <br /> Sampla Resutt: (s T X OR E) RANGE OF TOTAL POINTS 49 pts or note 41 - 43 pts 40 pts or lass <br /> B T X E 8 T X E <br /> `t MAXIMtfM ALLOWSLE Q-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. YA\3 <br /> Supte Result: GASOLINE 1000 100 10 <br /> 14AXIMIP ALLOWSLB TPM LEVELS (PPM) <br /> ^1 TPN -(r DIESEL 10,000 1000 100 <br /> FOOMTES: —If documented soft and/or ground water contmfnetion is present, do not comptete the teaching potential <br /> a:mlysfs. (i.e., site is eurrantty an UOT Cantaminetion List for soil or ground aster.) <br /> \1 If depth is 3, 5 ft. and < 25 ft., score 0 points. If depth a5 ft., do not use tabte. <br /> \2 If precipitation is 3, 40 inches, score 0 points. <br /> \3 levels for STXU are not apptieabie at a TPN concentration of 10 ppm (gssotfne) or 100 ppm (dieset). <br /> VI. STAFF RECOOMMATION/CONCLUSION <br /> 1. Are BTX L E or TPM Cancentrations 3, Attowebte Levets *Yes No <br /> 2. Retoewand Sita Ctosure Yes NO If Yes, Refer to Site Mitigation for Ewlustion <br /> VI1. REVIEW EVALUATION - TO NE COMPLETED BY A SUPEAVISOR/SEMIOR <br /> CON(= WITH STAFF RECOM IODATION FOR CLOSURE YES HOREFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EN 23 80 (UGTWKSHT)\5/90 <br /> � v�IGY a�F �`•r°'r'f?3,4Xm���9 Y 72.+o <br /> �- ���•,� �a.�n�G aozn w.•a 5 �cr7—,2���1.��1 �4� �v !�1 r35 <br />