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4 <br /> SAM JOAautM C(=T .'C_NEALTN SERvtCEs/ENviRt`HKMTAL NEALTN tt� A J� <br /> UCST 1Ct*KSNEET FOR SITE CLOSURE EVALUAT'l l <br /> t-- 00FACtt.tfY � �` • G © ,� / EPS cm / # d <br /> NESS J 41 <br /> to <br /> AMn StzE L TYPE <br /> i. CEN£3AL WE NISTORY <br /> S oer-W+c current? es a erwi t ! <br /> acltity Status Code t/G+ Gant as e <br /> r o1 forks at faelltty ge of Tanks(tf avattab(e) �s ypt of tankOust-r- <br /> us <br /> toot t t Ot <br /> I. MCC HISTCRY <br /> aI Tonk tested? es o aitad "Islam test tes a it yes, give date(s) <br /> as a r!peir wed* to the tank system? s No t yes, what was repaired? ��3 L <br /> .^ns repair done under inspection? as o re seat samples onetytoff es a TXE PN-G ►It-O /ti0t< <br /> type of failure/discharge ataserephfe oWt*rm leatsge erfitt cher: <br /> t+t`!O�/Al NtSTQRT (ATTACH INSPECTION REPORT FOR StyC OITAILS/COLLECT DATA FOR Ll=tMO POTENTIAL ANALYSTS) <br /> Coit samtes Received K e *pth to Gretand stater at/Year ; <br /> verage, Amuat PreeipIlan s 0-25 <br /> -lice vett(s) as e r t Type rr as <br /> ES core S re core <br /> istance to vetl(s) frac Tank tt: �_,._....ft: ft C 0 pts C POIs <br /> 0 f 0 if andittan R tt anditIan <br /> site Feature - Leaching Potential Aiatysfs E s am a wet <br /> Mimus oepth to greurdkoter from the Soft Saspta (fast) ' -50 1 <br /> rrur <br /> cetures in subsface COW I*$ to foothitts or eantain areas) Mane Unknownresent <br /> +y� rc <br /> rage Aual Precipitation (Inches) X= s10 10-23 26-40%2 <br /> an-!see conduits which increase vet•tfeat migration unknown Present <br /> I teachate (t.a., septic systems, water wits, pends) M <br /> ique site features: Rh <br /> ecarg* area, coarse sent, nearby watts. At toast fare-than-- <br /> Vont aones <br /> ne <br /> COLUM TOTALS»>TOTAL POINTS • ` <br /> onpte lesvtr. (t) T X OR E) RANGE OF TOTAL PO i S 9 pts or whore 41 43 pts M !MN N' leap <br /> MA WAW ALLOWME 1144-E LEvaa.CPp") 1 so So SO .3 3 1. t. NA3 <br /> mow <br /> s wvte xesuit: IME 1000 100 10 <br /> TPM <br /> t)tJN ALLOWLE TPN LEVELS (PPN) 18,000 1000 100 <br /> IESEL <br /> COTaotf%: •**if daeutanted soft and/or ground water contamination is present, do net earplete the teaching potential <br /> anstysfs. (i.e:. site Is a+rrentty on UCT Centreination List for soil er ground water-) <br /> \1 if depdt is v S ft. sed a 25 ft., $ewe 0 points. If depth a'f It., de not use table. <br /> \2 it precipitation Is * 40 inches, score 0 points. <br /> \3 Levels for BTXLE are/not appticatilt at a TPN concentration of 10 ppa (gaseitn*) or t00 ppm (diesel). <br /> !S �✓" <br /> :. STAFF RES091ENOATtOM/tC01Ctd7ltON �JQ�'•P � � <br /> t. Ar. 3TX L E or TPII Concentrations a Attewble Lavets Yes o d ` <br /> Yes Reltr to Site Mitigation for Evaluation <br /> 2. Reeoaewend Sit* Closure a it , <br /> i. jw.vleu EvALUArIGN • To SE CCWLETEO ITT A SUPERVISOR/UNION d"r <br /> -ow-".it JitA STAFF REtxF4EN0ATI01t FOR CLOSURE S EFERRfO TO SITE MITI AUCII FOR EVALUATICN S <br /> ATF TEFERREO ( / / ATE CLOSURE LETTER MAILED ' t / <br /> 7APf '7f <br /> Ex i3 so (ucnxs1tt)\3/90 <br />