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,VlC_S/ENVl RCNNENTAL :fEA, IOATEI — I <br /> SAN ICACUIN C,4ry PUBLIC XEAL�'XR Slic CLCSIIRE =/AL(LITICN <br /> II UGST 'JCRKSHET <br /> C/7 L. i i-U r YV e �, !— GC t� S ITANK 10 tt 510, <br /> � 7 S /SII lr <br /> OGI Gj I FUEL i YPE I D Sc..e. I O l w P I to <br />', 415iCRY Cxel f) I i IOae.Sai llG.I Gntt yes , IN° I <br /> . I lFaci Liry Stators L., <br />)nt? lYesl Nal IPernit . <br /> I Ouall <br /> IL 7., ( Type or (ani ! Sceell IFhr3ll ISn9l 1J <br /> at <br /> faciliryl IA9e at iartics( if available) 1/h.f� 3 � � ,TR <br /> ,,tt l <br />'Y I I I If les , give data( s ) Vv / 3i / / U' <br /> Yesl No <br /> NoI lFai led preci sign test � y9 Ja,�,yL _ <br />'d717 es l .� d <br /> l Nal ltt yes , WraL as r'pair^ds <br /> ode :o lye tank systeerr? Yes edllYesl INoI Ie^XEI ITPX ..f ITPH ] I lPh/E781 <br /> ie under Inspection? lYes l IHal I4ere sail sa®les anal'R <br /> III. scia,eI Icatastr°phicl Ilan9- teen leakage <br /> loverri til IunknaYnl loc,er: <br /> FCR SI a CE7AIL5/QLCT DATA PCR L=+IC.iIHG ?GTEM IAL ANALYSIS) <br /> 7CRY (ATTACH IRSPE?-TCN RE°CR7 ( Average AnmmL lrccipitatianlA= � t4 110- 5 <br /> I INoI IDa = to Ground III Ref/Year l <br />'IR ace i ved 17es I <br /> llrrl lOw IPuoI - Scar_ S IScnre <br /> s ) IYesl INoI INsyoer b TYAeI - C Score _ 9 cts Q 15 pts <br /> 0 pts <br /> Et ; C if rf condition <br /> I)el L ( s ) .'ran Tankl ccnditiw <br /> R c nai cion R is met <br /> 13 get I _ I is .Mt - <br />(cure Leaching loterttial Analysts I I 151 - al I l 5-i0\t <br /> > 100 I i <br /> 9raLx' ater *rao the Sail sample C `• r_c ) I i l I nK I lPresent <br /> Vane <br /> subsur'ace ( applies to faotnills or ma�tain areasl .l Ixxe l 25_40\2 l <br /> Iz�xu � <10 <br />!iaL orecipitatiw ( fumes ) i <br /> l I Unkrmas I Presort <br /> II migration More <br />;xvits vhicn inc.^e� , voter xtLs , pones ) ( Mare than <br /> I ( i . e_ , septic sys I I AL least ane <br /> ?eatures : Recharge area , <br /> coarse soil , neetT/ 'xils. � 4we ooe <br /> y- Q CCL!1MN TCTALS>r>i CTAL PCINTS l 1 l 11 <br /> 40 pts or Less <br /> X OR =) iQTAL PCINTS 49 pts or w" " 'as <br /> RANGE OF <br /> I!ilt : (9 X I = { 3 I • T I % I - I 4A\3 <br /> 3-i-X-? 3I 30I 50I i0 I .3 .S 1 . 1 _ <br /> ( NAXIMI➢1 ALLOWABLE L="VELS (PPM) <br /> t <br /> r,<rII �c IRE 1000 I 100 l 10IIIIIIIIIIg l { <br />�ult • -1{.- N I� ILE TPX l9VES (P") l WOO l t0a 111 <br /> II\\ MAXIM71 ALLL4AI) 0 [ESF 10 , 600 <br /> PN er1L oat cyp Late :he Leadsin9 potential <br /> Yater ccnpmi nati at is pees +atef • ) <br /> �^If Coamented sail and/or 3s-css>d L an UGT Contamination List Ear sail or grosT� ' <br /> Ing� araiysis. ( i "e_ , site is arrrsst a Points. I4 depds c5 do not use table_ <br /> t death is > 5 ft_ and < ft" • store (diesel ) - - <br /> \2 I ` pr. .. tatiw is 40 inctses , stare 0 Points_ -asoiine ) a 10U ,^Po <br /> \3 Leveis ear 3T%d� <br /> are not applicable at a TPN pncentr'anw of t0 ppn (g <br /> ascii <br /> ON/CCHCLUSICN <br /> X37% b c or iPN Caneentratiom > AL LoYabie Levels I ^esi <br /> No <br /> i if Yes . Refer to Site 4iti93tiw for EValuatiwl <br /> CloSurelYesl NaI <br /> j EVALUATlCN - i0 3E =MPLETO 3Y A SUpRVISCH/S�XICR <br /> ( NCI IRE=RREO !0 SITE MI7TGATICN :-CR 3VAWATTCNIYE51 1N61 l <br /> ITH STAFF lEcc4mmENDAITCH FCR CLCSUREIYESI ,l <br /> IOAic :CSURE L-'T cR <br /> 4.41101 / <br /> L-RREDI <br /> OR <br /> IC (UGT. WKSHT ) \5190 <br />