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waw r.waw�w WAmjI 'vers. wwwra "ALIN DIVISIaI <br /> I. UGC` 'i0RKSNEET FOR SITE CLOSURE EVALUATION DATE <br /> NAME OF FACILITY <br /> mum 3 b G FK zjJ TANK 111 N <br /> TANK SIZE'9-, FUEL TYPE n <br /> I!. GENERAL SITE HISTORY `v <br /> Is perait current? Yes No Penit N - Facility Stator Code Doc.SOil/GW Cant Yes No <br /> Number of Tanks at facility Ape of Tanks(if available) Type of Tank staet Fbrgl Shpt Dural <br /> LII. TANK HISTORY L _ o'�S/1 �,� �ct� 7 <br /> Was tank tested? Yes No I Failed precision test 7 Yes No If yes, give dates) <br /> Was a repair ride to the tank system? Yes No If yes, what was repaired? <br /> Was repair done under inapeetiaV as No Were soil suptes analyzed? Yes '- Mo BTXE TPH-G TPN-0 Pb/ED8 <br /> Type of faiture/dfscharge catastrophic towtare teskage overfill unknown otter: <br /> IV- REMOVAL NISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Seaptes Received Yes Mo 04pth to Ground Voter Ref/Year `" ; Average AnvAt Precipitation A= 1A 10.25 <br /> On-Site Wett(s) Yes No Huhber i Typo I Irr DaM Pub <br /> DistaS Sea" S Score S Seam <br /> nee to Wetl(s) fraw Tsnk 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 met <br /> Minima Depth to groundwater frac the Soft Sample (feet) 3"100 51-100 25.50\1 <br /> Fractures in subsurface Capplies to foothills or aasuain area) Nana Unknown Present <br /> Average Annual Precipitation (incurs) :anwnk <10 9 10-25 :o0onkxx 26-40\2 <br /> Man-Made conduits which fnereae vertical Migration <br /> Of leachate (i.e., septic systeon, water walls, ponds) None Un <br /> k:'am lj present <br /> Unique site features: Recharge area, coarse soft, nearby wells. At least Mon than <br /> Xoot:oa Nana ane one <br /> Q EP7il ALS>»TOTAL POINTS « • I- <br /> S811pte <br /> Result: /G(B� T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> A"�i"''` B T X I EB JT X E <br /> ?'� MAXIMIJR ALLOWIBLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1: NA\3 <br /> Saple Result: GASOLINE 1000 100 10 <br /> MAXIMUI ALLOWIBLE TPM LEVELS (PPM) <br /> DIESEL 10,000 1000 100 <br /> FOOTNOTES: *"If docuaMnted soft and/or ground water contamination is present, do not complete the teaching potential <br /> analysis. Cf.s., site is currently an UCT Contamination list for soil or ground water.) <br /> \1 If depth is > 5 ft. and -c 25 ft., score 0 points. If depth —5 ft., do not use table. <br /> \2 if precipitation is > 40 inches, sewn 0 points. <br /> L3 levels for BTXU are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMME DATION/CONCLUSION <br /> 1. Are BTX i E or TPN Concentrations > Allowable levels *Yes No <br /> 2. Ratowaend Site Ctaeun ria No If res, Refer to Site Mitigation for Evaluation <br /> Vit. REVIEW EVALUATION - TO RE CONPLITEO BY A SWERVISOR/SEXtQR <br /> CCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES <br /> ONNO <br /> DATE REFERRED / / OATS CLOSURE LETTER MAIL® <br /> NAME OF <br /> EVALUATOR <br /> EN 23 30 (U=XSHT)\5/90 <br />