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SAN 1CACUI)1 C Pl1SLIC HEAL;I SERVIC:S/ENVIRCNMENTAL :HEAL IVISICN <br /> I a.T '.CRY.SNE2T FCR SITECL:SURE c/ALUATICN OATE� <br /> NAME :F rAc.L:,Y SY 1GI( SCV`\/(CG1ov�__ ISLE=-Ps =E1 <br /> Aaoa�ssl "131 S acJ-loo �t � ITANK ID <br /> TANK SIZHIrJ,000 qo..l (FUEL ,TPE <br /> It. CENEZAL SITE :HIST T <br /> lIs pemic carrenc?IYes�X INoI IPeroit t� �'��� (Facility Stats Corel 0' IDoc.Soil/G� C�cI'!es`X i <br /> INunoer of ;arks at facility) L Age of TAnks(if avai[able)I3�y r !Type of TankisteellX Fbr3LI ISN(( Oval) <br /> III. TANK HISTCRY T <br /> Vas Tank cested?ITesl X No! Ifsilepre <br /> d cision test ?ITesl IN.!)( I(f yes, give dace(s) <br /> Was a repair cede :a the ;ink sys telt I Yes I 4.71 I f yes, winat was repo i red?!��-,��+ ��1uJ 4�-, a-dcl, ,o.,. 4. <br /> Las repair done urn r inspection?I Tes I INoI X IYere sail sawtes aralyzed?ITesI No! STXEI I7P4-G! ITP4-01 IPb/U <br /> (Type of failure/dischar9el cscastrophicl ILON-Cara Leakage) IaverfiLLl unknowh( other: I <br /> REiClAL 3ISTCR7 (�LTTAC9 INS?£CC;gI ZEPC2T FCR SITE DETAILS/CXLECT OAT,( FCR LEAL3ING \?OTE)ITIAL mmms) <br /> Soil Saaates Received Yes INoI Depth c0 arournd dater) IRef/Tearl Average Aman) Precipitation A-114 110-?_5 <br /> On-Site 'lell(s)IYes{ 1901,/ l9uat:er L Typal lIrrl IDoml IP,,bI <br /> S Score S Scare S Scare <br /> Oistarce t0 WeLL(s) frac Tank) ft; 't; ft C :0 acs C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R candiciOn R cardItfon R carditicn <br /> V. Sice ?esture - Leaching Poeerncial Aralysis _ is .net I c is ae[ = is pet <br /> Mininn Oept1 to 3rouridwacer from :he Sail Sa=te (feet) 1 I >100 I51-100 I — I ?5-50\1 l <br /> Frac:Lxes in subsurface (apolies :0 foodiMs or nour+c3in areas) I �1 None I I Unkricun I IPresert <br /> IAverige Arrx aL Precipitation (inches) xzzaxxl <10 I 9 I t0-eS (xxtrcal Z6-40\2 <br /> i <br /> Nan-.wade carxtjitz which increase vertfeal aigrstian <br /> Of '43C.-lateCI.e., septic system, water '-tills, ponds) I Nome Urkrsa+sn Present <br /> Unicue site fescures: ReCiarge area, :parse soil, seamy wells. I I I At Least (Mar• :a <br /> None WAR <br /> =LL291 TOTALS?»TOTAL POWS + • <br /> Saaale .Result: C3 T X E) RANG'c :F TOTAL POINTS149 pts or sari I :i - :a pts I SO pts or Less <br /> 3 I,Qy X LAS <br /> J I 5 5 E (o30 AAXIMAI ALLCUASL: 3-t-X-° L,"VELS CPM <br /> P ) II 50 533 3T X01 50 I . . 11.( <br /> Spools Result: GASOLINE 1000 ! ',00 I 10 I <br /> MAXI}l:Il ALLCI-IASL: TP4 L-=MLS (PPM? <br /> ,�S,L2C. '3 TPR DIESEL 10,:00 I 1000 I 100 <br /> FOCTNOT'cS: " !f doameneed sail and/or grou sister _antaminatian is present, do not c=wtete the las=jng potential <br /> analysis. (I.a-, sits is zur—rcly on UC Contamination List for sail or groused Mcar.) <br /> \1 If dept's is > 5 Pt. and < Z5 ft-, scare 0 points_ If deed's -r5 ft do roc Vee tabte- <br /> \2 if precipitatian is > 4 inezes, scare a ,points. <br /> \3 Levels for 3TXSE are roc apptic=La at a TP4 concentration of 10 Xm (4asatine) ar 100 P= (diesel). <br /> 71. STAFF REC..4MENDATICN/CHIC USICXI T�,_�_(_ <br /> 1. are 3TX 1 : or TP4 AtLawaote LevelsIVyes1 No <br /> Z. 2ec=mes Site C;asurelTesl INoi res, Refer :a Site ?litigation for ;valuation} <br /> VII. RFITEY /ALUATICX - TO 3E =MPI-2717. 3T A SLPEZYISCSt/ ICR <br /> C:rGR VIT! rLFF ZvC=X1ENDATIC7i .CR »C E!-Est IMCI IRE—ruR.J TD SITE lITIGATIC7l FGR =lAL'r.17IC3ilYE51"JN01 <br /> IoAT'c IE=_3RUI / ,U / IOA1c ==ME ,s1A1L7, <br /> I <br /> (NAME :F i <br /> clAL ATCR� <br /> .H ZZ 20 C,,; .XSHT;\Si90 <br />