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SAN 1CACLIEH C J7U9LiC 4EALT4 SE.RVI�SlE4vIRCNMEMTAL HEAsf A 1EVI5ECH paTEI <br /> _f IXRKSHEET FOR SI i c'CL=RE /ALLWICH is <br /> MANE IF �aCILSTY I zq <br /> TANK to <br /> IADCRESSI { - <br /> BANK SIZE W: 1Ze. iYPQ� <br /> I, L"t_34ERAL SITE 4ISTCRY <br /> Facili� Stars Cadet IDoc.SaiL/C;.i Cant Yesl IHol t <br /> Is �eratit current? Yesl IHaI/IPesrait / t ` <br /> 'Age 1r idn1C5(1T 3ValEatsle) ? !Type of Tank�Stecll ;F:rgll (Sngl� Duan I <br /> !vunber 0f Tanks at facility) !! t <br /> iI. TANK HISTOR7 <br /> :,.as Tank tested? Yes IHa� Failed precision test .I7esI �NaI ILf yes, 3i'K date(s)I <br /> .4a4 If yes, what <br /> `.as a re.air ,fie to ,i•re -ark systeafl I Yes I j � <br /> :,.;as r min dere vr+c'er insaectian7lYesl <br /> Mai were sail. sampies analyzea?IYesI IHaf CiTXE� TaH-' ITPN•0I �Pb/E]SI <br /> i <br /> atter: <br /> 'ype or =aiture/disc�argef Iratastrachicl I[cng-term Leakage! averfiEl <br />:V. iFlieVAL HISTORY (ATTACH IHSFECTICIN REACRT =OR 'slit ]£TAILS/C:.t =C; OATa ~7R =AC.iIHG POTc-liTIAL .ANALYSIS) <br /> Average Arr+uaL Precipitation A- 14 I10-S I i <br /> Ref/Year� i <br /> Suil Samples RecaivedlYesl NaI Itlepth :a Gcatr�d uaterl � ( I � <br /> q no Nemxr b Type) ilrrl IDamli Pva� I Scare <br /> Cn-Site uelL(s) Y <br /> I , sl I IXI SSpre S �SC•re 5 <br /> jet tram Tankl ft: .� C if D pts C 4 pts G � <br /> Distance to - 0 Ia rc <br /> 2 csidic:enl 2 c=+Gitian R cr3itian <br /> c is xt _ is .►et _ is met <br /> V. Site r-eature - Lasing ?aterrrial Analysis <br /> !ct-iCD <br /> '`Minimun depth to gro�u>Ct+atar cram 'fe Soil Sample Cfeec) '7 V'I C I 'LOCI I <br /> j r I Unicrown Ipresent I <br /> IFr3ctures in sesa=sur=acs CaelsLies to foathilts or .;sustain ar-asl I ! c) I Vane I <br /> I:oac=l <1a I 9 I tD-= I,r�c:ooccl <br /> !Average Annual Precipitation (iisCtes) t <br /> !man-made Conduits ah i ct increase ver-il=l mi gray en ttniee a++n � l Present <br /> 1r , Septic System, water wet Lz, ;-.on=) � , <br /> I At teas: Mare than I <br /> !Unique site features: jecharge <br /> area, coarse sail, neardY wells. � e ane ere <br /> C.^.LUNN TOTALA»TOTAL POINTS <br /> ! 1" L1 - =3 �s »n Sts or f ess <br /> SamCle 2esuit: C3"T X OR =) RANG�c OF TOTAL POINTS 1-9 pts or mar�� <br /> _� <br /> ►k .� I X x_ 1. NAu <br /> NA)(IItI ALLL1iABL= 3-i-X-c L_�lEs_S.CPP!!) 1 <br /> GascL HE 1Dt� 100 I i0 <br /> Sam to Result: I L' a Teti L_CVELS {PPM) <br /> MAXIMUM aLLnuAeL. DIE5� 1a,0DD 1CD0 k lea I i <br /> TPHp <br /> r TH[)TES: " If documented sail and/or graursd waver �taminatiaee is pressttz, do <br /> ' etre leaching potential <br /> ,,} CJ Ci7P1 {� analysis_ Ci.e., site is currencty an �2GT L;Ca inazian List for soiC or ground +atm' ) <br /> IU;Ul \S If. desxh is > > `L. and C 25 ft., score a points_ If oe�t ms's ft_, Ca not use mate. <br /> \2 If precipitation rs 3- 40 inches, scare 0 ;Miffs_ <br /> Lev for 3T)ISE ate not aeplicaole at TPN =r=,mration of 1S ppm (3asatine) ar 100 Cdiese+)_ <br /> n a- <br /> VI. STAFF RECCMMENDATTOM/CCMCLIISION <br /> 1_ Are 3TX 3 E or TPH Cancentratians ' ALtowabie !vets I"esl I f L <br /> � Serer Co Size:'litigation for =vaLuatian <br /> ? 3ecattsmend site Clasurel7esl Haj irtf Yes /v V C`'`am old ��cJ <br /> VII. 2ElIEW elALUATICH TO 3E cM4pt,F.TED 3Y A Ss3PE4VISCR/S0lcR <br /> CATION FCRCLOSURE(YES�. jaDt �REr-RRE) To Slic .'IITIGATICN: FOR �.lALLU1TIC)N�YE5� �H01 <br /> IC,:NC1R 'aITH STaF= R1=£�MME'i ; <br /> OAT'c REFERRE]i / <br /> / IOATc c_OsystF_ L_-tT0 MAID) <br /> NAME OF I <br /> EVALUATOR tom; , <br /> iH 23 30 CUGTUKSHT?\5/90 4-0 <br />