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EVALUATIOa_ac ..� �,« a�wvac��i�w.wo.w+«MC N a—•"w ATE lZ-Z3--T <br /> UGST YORKSNEET FOR SITE CLOSURE <br /> WEEPS CODE TAN (1 2 <br /> AHE OF FpCiLITY DICSe�d �e r•�v�r�A-�� - <br /> ( �^, S <br /> tU�l K ID 7ti <br /> DDRESS 04 e. S}flGk <br /> t~Y eY�'�DYI� �T• <br /> ANK SIZE 3,oDD UEL TYPE Un <br /> 11. GENERAL SITE HISTORY <br /> Is permit current? es o ermit a <br /> acility Status Code $ I oc.Soil/GW Con as �o <br /> e of Tanks(lf available) k ype of Tank teel brgl ngl Dual <br /> umber of Tanks at facility t g U41 <br /> I11. TANK HISTORY <br /> ailed precision test es <br /> o if yes, give <br /> as Tank tested? es o <br /> as a repair made to the tank system? es No f yes, What was repaired? a G H D /EDB <br /> ' as repair done under inspection? es o ere soil samples analyzed? es o TXE <br /> na+n ther: <br /> ype of failure/discharge atastrophic long-term leakage verfill <br /> 1V. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> verage Annual Precipitation 4 10-25 <br /> ,oil Samples Received es o <br /> epth to Ground eater t' of/Year = <br /> -Site Wells) es o umber & Type 1rr om ub S core S core <br /> S core <br /> @ ft C 0 pts C pts C pts <br /> istance to WeIL(s) from Tank -ft; ft; 0 if 0 if 0 f <br /> E is met <br /> ondition R ondition <br /> R ondition E is met E 's met <br /> Site Feature - Leaching Potential Analysis r 25-50\1 <br /> s�� >100 1-100 <br /> inimum Depth to groundwater from the Soil Sample (feet) Uresent <br /> 'b None Unknown <br /> ractures in subsurface (applies to foothills or mountain areas) 9 10.25 xxxxxx 26-40\2 <br /> xxxxx <10 <br /> verage Annual Precipitation (inches) <br /> an-Made conduits which increase vertical migration Unknown resent <br /> None <br /> hte <br /> f leachate (i. ., septic systems, water wells, ponds)f At least ore than <br /> Inique site features: Recharge area, coarse soil, nearby wells. xxxxx None <br /> one one <br /> to a� 5 <br /> COLUMN TOTALS»>TOTAL POINTS 40 pts or less <br /> RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts <br /> ample Result: (s T X OR E) g T X E <br /> »� l3Dppt7 6 T X E NA\3 <br /> MAXIMUM ALLOWABLE B-T•X-E LEVELS (PPM) 1 50 50 50 •3 '3 1• 10 <br /> ASOLINE 1000 100 <br /> ample Result: 1000 100 <br /> .g fPt}-d �'OSt'�° AXiMUM ALLOWABLE TPH LEVELS (PPM) IESEL 10,000 <br /> 431 t7.D I,yoo pPt ent i a l <br /> OOTNOTES: <br /> ***If documented soil and/or ground water contamination is present, do not complete the leaching po <br /> i analysis. (i.e., site is currently on UGT -Contamination fist for dornotlusertable.d water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <br /> \2 If precipitation is > 40 inchesable at a TpHnconcentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> \3 levels for BTX&E are not app <br /> V1. STAFF RECOMMENDATION/CONCLUSION /77-7 <br /> Io <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels=toSit, <br /> 2. Recommend Site Closure es oif Yes, Refer Mitigation for Evaluation <br /> VI1. REVIEW EVALUATION - TO BE C014PLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE 'ES <br /> p EFERRED TO SITE MITIGATION FOR EVALUATION ES=40 <br /> ATE REFERRED / / <br /> ATE CLOSURE LETTER MAILED <br /> AME OF <br /> .VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> Ex 29 80 <br /> -- <br />