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SAN JCACUTA CO PUBLIC HEALTH SERVICE31=HVIRCNMENTAL HEALT VISICH <br /> I• U,._,- VCRZSHEcT FOR SITE CLOSURE .VALUATICN DATE -?44(,�44 <br /> NAME OF FACILIT7 1�t C.� o� ISWEEPS CME( �/ O <br /> IADDRE3S1 3iJ 00 1 (TANK ID .I i YJIJ ' W <br /> TANK SIZE4 �i FUEL T fPE L"DUNGEAD <br /> II. GENE UL SITE SIS Y <br /> ftY <br /> Is Permit current?IYes x 1Mo Permit $1 ' p 1Facility Status code 1Doc.Soil/1761 Cant lYes Not <br /> Nunber of Tanks at facility+ .[Sl Age of Tanks(if available) —so Type of Tank ISte*( Fbrgl ISngLI Dual <br /> I11. TANK 4ISTCRT <br /> leas Tank :ested?I7esl�,, NoI (Failed precision test T Yes IN,ICh IIf yes, give date(s) <br /> Was a repair mode to the tuck system? Yes1 No lIf yes, what was repaired?_>cw,�,,.- -A(V_a77, <br /> )Vas repair done under inspection? Tea INo1 jWere sail samples analyzed7lYesl INaI STXE1 TP1f-G1 1TP'1-01 IPb/E]81 <br /> Type of failure/discharge (catastrophicI hong-term leakage) overfill) unknownlx other: <br /> IV. REMOVAL HISTORY (ATTACS INSP£CTICM REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes Not Depth to Grand Vater) Ref/Year Average Annual Preeipitat Ion1A- 14 110-25 <br /> IOn-Size 'Jell(s)1Yes 1 Nal, Number & Type1 llrrl 0= Pub <br /> S Score S Score S Score <br /> Distance to ueLL(s) from Tank1 ft; ft; ft C 10 Pts C 9 pcs C 5 PCs <br /> 0 if 0 if 0 if <br /> R condition R condition R conditicn <br /> V. Site 2eature - Leaching Potential Analysis _ is net I "c is net _ is .net <br /> IMinimun Depth to groundwater from the Soil Sample (feet) I >100 I51-100 1 1 25-50\1 <br /> (frac:ores in subsurface (applies to foothills or mountain areas) I —•I Pone 1 1 Unknown I (Present <br /> Average Annual Precipitation (inches) xxxxxxl <10 I 9 1 10-25 x===j 25-40\2 <br /> (Man-.Rade conduits which increase vertical migration I I ` I jPresent <br /> of Leachate (I.e., septic systems, water wells, Ponds) t✓' Nont UrJasawarm <br /> IUnique site features: Recharge area, coarse soil, nearby wells. qI At Least) (More than <br /> MW*xx== Ne 1 one one <br /> CCLLM 70TAL9»TOTAL POINTS <br /> Sammie Iesutz: (3 T X OR .) RANGc OF TOTAL POINTS 49 PCs or pore 1 41 - 48 pts 40 Pts or less <br /> — G k C,,,4 s <br /> UXI" ALLOM 3-T-X-a- L.E'IELS (PPM) 3` Taj 50 ) 50 I .3 J.T <br /> 3 X.I 1. I NA\3 <br /> Sample Result: GASOLINE 1000 1 1a0 1 10 <br /> MAXI" ALL3ML_ TPI LEVELS (PPM) <br /> 1,5C TPH DIESEL 10,000 ( 1010 1 1CO <br /> FOOTNOTES: '"If documented soil and/or ground water contamination is present, do not camolete the Leaching potential <br /> analysis. (i.a., site is currently on UGT Contamination List for sail or ground water.) <br /> \1 If depth is > 5 ft. and < Z5 ft., score 0 Points. It depth —i ft., do mc use table. <br /> \2 If precipitation is > 40 inches, scars 0 Points. <br /> \3 Levels for 3TXd.E are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> 'ft. STAFF REC�l1E'10ATICM/11711-USIC11 ^,'� <br /> 1. Are 3TX 1 . or TPH Concentrations > Allowable levels I*Yesl INal <br /> Z. Recomend Sita CtosurvlTesl Nal Loo f yes, Refer to Sita Mitigation for evaluation' <br /> VII. I VIEV VIALUATICH - TO 3E a"LETcMi 3Y A SL9ERVI SEYICR <br /> CCNCIR 'JITH STAFF .:MCCME.DATICN ;CR :LC=EIYESV ANO) IREFEUM i0 SITE MITIGATICN FCR Z-VALUATICNIYES{ NC! <br /> OAT. .2E=cRRE'Ol / U / (DATE C1 OV IRS 1-277ERMAI U0 / ! <br /> NAME �f <br /> IEVALUATCR <br /> :-H d3 30 (UGT•.'KSHT)\5/90 <br />