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SAN dOAOUIR PUBLIC 4EALTk SERViCS/E'IVIRQNlN.YTAL MEA LiI+ ' RSION <br /> I, _10JORKSHE:- M SITE CLOSURE VALUATION i OATS) <br /> NAME OF FACILE ISS" OE� <br /> �ADORESsI ITANK �:.. ' <br /> (TANK SIZE (FUEL TYPHI I <br /> II. EMRAL SITE 41STClY <br /> Is rermit eurrant?IYesl INoI �Penait 3 !Facility status CodeIaoe-Snit/GH Cant Yesl Imal <br /> Numoer of Tanks at facility I"* of Tanks0f aysi tante)l (Type of Tam+kl Steel l `Fbrgl f ISngt` oust) <br /> :11. TANK NISTCRY <br /> was Tank tested?IYes lNol !Faded precision cast ?IYes IN01 fif yes, giw data(s) / / <br /> ras a repair made to the ink sys;ah?IYes Nol It yes, what was repaired?) <br /> ;vas -=air done under inspeesion?Nre eal ImaI Hasoil makes anelyzee?IYesl INa) aml ITPN-GI ITPM)' IPb/Ei381 <br /> 'yge of failure/discharge! Iestastrapi�icl Ilona-term leakagel laverfilll Iunknownl lather: <br /> i4. iE'!WAL HISTORY (ATTACH INSPEC'iION MORT FOR SIT$ 0ETAILS/C3=-C4 OATA FOR LEACiING POt'e.YTIAL ANALYSIS) <br /> :Soil Samples ReeeivedlYesl Na leepth to Ground Nater l20/7esrl !Average Aehnual PreeipitatianlA-114 110-251 <br /> ICM-Site W*LL(s)IYesl ING1 I*Aimr L Typal Irrl IO,mI IPWl s Scors S Sere S Score <br /> frac Tank ft- ft; ft C 110 pts C 9 :sts C 5 pts <br /> O i s anew to deo L Cs) <br /> 0 if 0 if O if <br /> R condition a ., ition a condition <br /> IV. Site Feeture - Lasehing Potential Analysis _ is AMC is met Ze is met <br /> Minimum Depth :o smaul+ater from theSohl smote (feet) I I >Io0 I 5i-iCfJ f 12'�-i0\1 <br /> IF-aessres in suosursace (applies to footliLis or aountain areas) i Lar I I Unxna++n ' IAresent ( ' <br /> l I 1l <br /> ,average Annual Precipitation <inehas) l e10 9 10-s'5 :0000= 2b-404Z <br /> `.,ysn-Made conduits which ineresse' varticat migration I <br /> o{ leschste (i.o., septic systems, water ye(ls, ponds) 'lens Unin.ae� I S Presaeht <br /> Unicue site features: Recharge ares, c*erse soil, nesrtly wens. lx==l 40MAt Le4t� More than <br /> one <br /> 1 gLUMI TQTALS)P»tOtAt. POINTS <br /> I I - LI • t E- t <br /> Samcte gesuit: (S T x OR E) UNGE OF TOTAL POINTS L9 pts W More I t.1 . 4$ ,ics I 40 PCs or Less I <br /> MAXIIY/ ALLOWABLE 3-T-X-Q LEVELS (P") 1� M SO 50 , 3 -3 1.!.l <br /> t. � NA\3 <br /> :Smote Resutt: rasaLtNE 1000 I 100 I t0 <br /> INVMM ALLOWABLE TPN LEYMS (PPM) <br /> TP" OIESgL 10,000 I t000 too <br /> FOOTNOTHS: "'If doctmhemcsd soil and/or ground water cohhtsmination is praa.nc, do nal camotate the lemcning pacantist <br /> analysis. (i.e., site is =7,mcty an UST Cancasinetion List for soil or ground rate'•) <br /> i \1 if death is > S ft. and < 25 ft., scare 0 points. If depth cd ft., do nac use table_ <br /> \2 if precipitation is > 40 inches, sere 0 points. <br /> i \3 Lerets for 51=9 are mc applicable sic a TPN cmic nd-atian of 10 ppm Cgasoifns) ar 100 go Cdieset). <br /> V1. STAFF m!CCM0MATIOM/CMlCLUZIOM <br /> 1. Are 3TX h E or TPN Cane ncratia m > A4loreiate Levets I*yesl INoI <br /> 2. teco mend Site CtosurelYasl INal llf Yes, Refer to Site Mitigation for :vatustion� <br /> VII. 2E'/fEN EVALUATION - To 3E COMEM 3Y A SI YtSOR/MIOR <br /> =aM NITH STAFF RECCO ENDATTCM FOR w.0s lElYt14� INol IMM3RED TO SITE -UTIGAT1ON RM RVALUATIONIYESI lNai I <br /> DA—,. UPSUE+]I IOATE CLOSURE LETTER MAILMI I <br /> NAME OF <br /> EVALUATOR <br /> EM 23 80 (UG7UKSMT)\5/9O <br />