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�60 7 e—, <br /> 4VIROHRE'I'AL HEALrH� IH 4 <br /> SAN .OACUtli COUlFt,� IC 91ALrN 5c=VIC�SlE / Aie U�Z7i (� <br /> U ;,,dXSHEET FOR SITE CLOSURE EVALVAT•ICH <br /> II ' .IE EPS LODE <br /> FeSf ¢moi .l�ll��/ <br /> OOR£55 � <br /> 69 r �l <br /> rANX SIZE <br /> raj Zs^ UEL ryPE zq OL <br /> i <br /> It. GENERAL SITE HISTORT e: <br /> I <br /> Is Perri: currenC? es a !retic 3 <br /> �acility Sracus Cade oc.SaitlG'J Cor+c `es a <br /> umber of Tanks at facility <br /> ge of Tanks(if available) ype of Tank tee! brgl rgt OuiaL <br /> IIT. TANX HISTCRY <br /> as rank tested? � eS a ailed precision test 1 es a If yes, give date(sl <br /> as a repair made to the tank system? �es Yo f yes, what was repaired?l <br /> ,s repair done under irspection? es a er± soil safroles analY=ed? I es o <br /> ME ` PH-GPH-0 a/t D8 <br /> ype of faiture/discharge atasrroptwia Long-term leakage verfitl own cher: <br /> [V. AF-MOVAL '!(STOAT (ATTAC-H! IMSPECTIC24 UPORT FOR SITE OETAILSIMLEC DATA FCR 14AC.4I8G POTENTIAL AAALTSIS) <br /> oil Samotes Received Yes a epch to Ground eater of/Year verage Arr+uat Precipitation i = L 0-25 <br /> -Site '�eLl(s) es a t,mber b Type Irr �om b <br /> S core S care S care <br /> C pts <br /> istance to well($) from Tank ft; ft; ft C f P ifis C pts C f <br /> Z and i andition R andicion <br /> 3 met is m t s met <br /> Site Feature - Leaching Potential Analysis <br /> • � I <br /> • � � ZS-5011 <br /> 1'1C0 <br /> Minimum Oepth to grata-dwater from the Sail Saw Le fleet} > 00 r <br /> Unknowin resent <br /> Fractures in subsurface (applies to foothills ar maintain areas) <br /> xxx�c0-ZS �s ZS-40\2. <br /> Average Annual Precipitation (inches) --.0o <br /> wan-Hada conceits which: increase vertical migration vil resent <br /> if Leachate (i.e., septic systems, water wells, pands) Mane f <br /> At a iare than <br /> LniWesite features: Recharge area, coarse gait, nearby wells. <br /> � Vona one <br /> CMLM TOTALSs»TOTAL PO(YTS ' } <br /> ample desu� 'ACS Y�%�R e7_ <br /> RANG$ OF TOTAL POINTS 9 pts br more 41 - 48 pts 40 pts a Less <br /> q 11 Ub i/` �w�((�� 3 T x E 3 1 1MXIHtr! ALLOUA8LE 3-T-X-e" L:VELS (PPH) t 50 SO 50 .3 J.T <br /> 3 t. 1. YA\3 <br /> ample desalt: yf/0 O <br /> aLIHE iota Ica to <br /> J''7 I" ALLOVReLE TI'H LEMS CPPM] tOa <br /> TP IESEL 20,000 1000, <br /> COr11aiES: if deetanented gait and/or ground racer contamination is present, do not Complete the teaching potential <br /> analysis. (i.e., site is currently an UGT Contamination List for soil ar grasr+d water.} <br /> \1 If depth is > 5 ft. and < Z5 ft., scare 0 points. If depth <--5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXSE are not applicable at a TPR Concentration o 10 ;pm Cgasotine) or 100 p,M (diesel). <br /> STAFF R£CC4'"E41DATI09/CCNCLUSI0N <br /> 1. Are 3TX Ii E or TPH Concentrations > Alla ble Levels Tes <br /> 2. xecom-pend site Ctosure es o If yes, 3efer to site Hitigation for Evaluation <br /> :I. tE'11EV EVALUATiCN - TO 3E GCKPLETEO 3Y A SUP£ZVISCRMNi <br /> O4C'R ;PITH STAFF dECCHFlEVOATiON rFOR CLOSURE �SS E EE REO TO SITUMITIGATICH FOR EVAU3ATICN ES I 0 <br /> ATE REF_Rtt£a / / TE CLOSURE LETTER 4AILE() ` f / { <br /> IAnE OF <br /> :VALUATOR <br /> EH 23 as (UGTVXSHT)\5/9O <br />