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SAN :CACV.'X CajNTT Pf HEALTH Se{V[C S7�c[+�cw�t+.ti� sr-ni�n WL-1 rACc <br /> UCS ' '�HE_T FCR SITE CLGSLII� :7AL<aATICH P <br />:E CF FACILITY <br /> TRESS GYJ� l ANz ID Y <br /> Ix SIZEUEL TYPE I ` a <br /> Ic![EUL I,4 :•IISTCRT D <br />;emit current? les a :emit s - aeitiCy Scaeus Cade oa.Sait/G•J Canc es o <br /> x+er of ranks at facility �ge of ranks(if avaitabte) ype of tank �zceL be;t Isngl Duat <br /> TANX 91STCRT <br /> Tank tes;ed7 fes (o aiI'ed Preefsion test 7 -Yes,,' , o If yes, give date(s) ! <br /> a repair .wade to the tank sysCesit es � Va t yes, what vas repaired? <br /> repair done u-der inspection? �es �fa re sail samples anatyxedT files a TXE PH-�'. �PN•D b1GDe <br /> e of faitureldise4arge acastrophic [Ong-term teak age Pverfi[L cher: <br /> E."-OVAL .41STCRT (ATTACj tXS?ECTICH 2E?CRT FOR SITE DETAIL LLECI DATA FCR FOR POTENTIAL ANALYSIS) <br /> I <br /> i Sa+aptes .2eceivr! es a epch to Grecr�d eater of/Tear ��Average Arnual Precipitation - 14 IIO-l5 <br /> Si to Uett(s) 'Yes � a l canter L Type I � ot <br /> S core S car± S cre i <br /> Cance ca Ue[I(s) from Tank ft; ft; ft C 0 pts C pts C pts <br /> 0 •f 0 it O f � <br /> 2 ondition x .ndicion 2 or-di c!on <br /> Site Feature - Leaching Potentia,( Analysis i. •s out $ is met Es met <br /> im[raDepth to grairti4+ater from :he Salt Smpte (feet} >100 1ItlO l25-5 <br /> 0\I <br /> e;urea in sui:surface (applies to foothills or mountain areas) Nene r Unknaun Iresenc <br /> raga Arcual Preeipicatian (inches) I 410 4 t0-25cxxxszz 125-40\2 <br />-wade -.omits .hie`[ increase ver:.icat migration <br /> Lesc, . (i.e., septic systems, water welLs, ponds) Vane Unicno+.n resent E <br /> g:e site features: Xec.'iarge area, aaarse salt, nearby welts- Ac leasore than <br /> cone one one <br /> CCLLR':V iQTALS»>TQTAL POINTS <br /> ote 2esutz: (fi T X CR 5} LUCE OF TOTAL POINTS 4 pcs or more 41 - 4a pts 40 pts or Less <br /> � 7- <br /> 3 T X 3 T X <br /> Z / x MAXI'.LH ALLCUASLE 3-T-X LEVELS (PPM) I I SO 150 SO .3 .3 1. VA\3 <br /> pie <br /> 2esul;: I CLIME 1(00 100 SO ;( <br /> IKJX ALLCLARL3 IPH LEVELS (PPM) 100 <br /> TPR I!I! IESEL 10,000 1CC0 <br /> CN0T.5: ,"If docurienced salt and/or gres-d water contamination is present, do roc caeptete cite teaching pocenei <br /> � at <br /> aralys(s.; (i.e., site is currencty an UGT Contaainatfan Lisc for salt or graerd water.) <br /> \1 If dept.,, is > S ft. and < 25 ft., scare 0 ,points. If dept:[ <=5 ft., do not use tabte. <br /> \Z If precipitation is > 40 int.,,es, scare 0 points. i <br /> 13 Levels for 3TX3cilare not applicable at a TPH ceneencracien of 10 ;m CSasatine) or Joe ;pn (diesel). <br /> rAFF 2EC—'WEUDATICU/CCRC.USICU ! <br /> Are 3TX S. = or TPN Coneencratiarts > Attawabte Levels <br /> 2ecoavier+d Site Ctosure es '.a ✓ If Yes, Refer to Site Mitigation for avatuacion <br /> 1EVIE'd EVALUATICU - TQ 3E =PUTTED 3Y A St.VS3V1SC2/SZXICR <br /> 4=2 'Ji TA STAFF AECCOMENDATICIf FCA CLOSURE TES j 4 E:=1RE0 TQ SITE MtTIGA7ICN FCR _t7ALUATICH Ea FC1 <br /> E ZEi=3TE7 I / / �ATc L=R£ L_TTE2 MAILED I , 't ! <br />'E CF <br /> ILUATCR <br /> 23 d0 (trc�xsai)1sr/S0 , <br /> i� i <br />