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SAN OACCs,N iCzl 11t HEALTH SERVICZS/EHVIRCNMENTAL HEALTH ICN <br /> U zSxEE' FOR SITE CLOSURE EYALUATICN AIE <br /> !+AME CF FACILITT 9 {G�l rT-_PS CCOE A� <br /> r/ 7? <br /> +aDaEss I .2Gr V'1i117Y711S ANX ID x 3 - /�6. <br /> iIAXX SIZE 1000 : UEL TYPE <br /> CENERAL SITE HISTORY <br /> ,is permit current? es o ermit 3 ��j acility Stares Code d oe-Sail/Ci1 Cant es o <br /> ;vtjncer of Tanks at tacit ity ge of Tanks(if available) ype of Tank teal brgtmgt Dual <br /> I. TANX HISTORY <br /> .ins Tank tested? 16s . ✓ o ailed preeisien test 7 es a if yes, give date(s) <br /> .:as a repair made to the tank system? es Nof yes, sestat was repaired? <br /> ,:ns repair done under:inspection? iy <br /> es o ere soil samptes analyzed7 es t,TXE I PH-C -ITPH-0 b/EDS 1 <br /> 'ype of faiture/discharge catastrophic tong-term teakage verfi[t n cher: r <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ;oiL Samptes Received es o epth to Ground Vater J', of/Year G verage Annual Precipitation <br /> I <br /> 7n-Site Welt(s) es 14-1 o L-*X-r d Type Irr ceabt 4 <br /> S cora 5 scare S core <br /> 7istance to We1t(s) from Tank I5 3,ft; ft; ft C 10 pts C 7 pts C pts <br /> 0 if 0 if 0 f <br /> R ondition R condition R ordition <br /> V. Site Feature - Leaching Potential Anatysis E is met E is met E s met <br /> iinimua Depth to groundwater from the Soil Swpte Veet) t� / '100 1-100 25-50\1 <br /> 'ractures in subsurface (applies to foothills or moLntain areas) None Unknown I resent <br /> :verage Amuat Precipitation (inches) xxxxxx <10 9 10.25 xxxxxx x 25-40\2 <br /> :an-made _onduits which increase verricat migration 1� 3 <br /> )f leachate (i.e., septic"system, water wells, ponds) we Unknown resent <br /> 'nique site features: Recharge area, coarse sail, nearby wells. I � fat least ore than <br /> xxxx Il None II one one <br /> I <br /> CCLUMH TOTALS»'TOTAL POINTS * • �J ' <br /> Tsmpte ,Result: (B T X OR E) RANGE OF TOTAL POINTS19 pts or more 41 - 48 pts 40 pts or less <br /> r 7A ,y I ,ryrv� ffT E 8T X E <br /> MAXIMlS ALLLVABL'e $-T•X-E LEVELS (PPM) 50 .3 .3 1- 1- NA\3 <br /> 3ampte Result: OLiNE 1000 100 10 <br /> I" ALLOS.ASLE TPN LEVELS (PPM) <br /> f TPH^[7 IESEL 10,000 1000 100 , <br /> 'COt!tOIES: *—If documented soil and/or ground water contamination is present, do not cemplete the teaching potential <br /> analysis. (i.e., site is currencty on UGT Contamination List for soil or ground water-) <br /> \1 if depth is > 5 ft. and < 25 ft., score 0 points. If depth -5 ft., do not use table. <br /> \2 If,precipitation is > 40 mollies, score 0 points. <br /> \3 Levels for $TXRE are not applicable at a TPH concentration of 10 p;n (gasoline) or 100 ppm (diesel). <br /> 11 i <br /> STAFF RECCAHENDATICN/CCNCLUSIOH Ml�TdrS a v� A NO, <br /> 1. Are SIX I` E or TPH Concentrations > Attowabte Levels Yes <br /> 2. Rr_omtxrd Site Closure es o cu <br /> If Yes, Refer to Site Mitigation for Evaation �N 5(7M31Ky l <br /> REVIEW EYALUATICH -..To Se CrMPLETED BY A SLIP ERVISCR/SENIOR <br /> }ZDHC•JR U11H STAFF RECCHME40AT[ON FCR CLOSURE ItES I O EFERREO TO SITE }IITIGATICH FOR EVALUATION �ES 0 1 <br /> GATE REFERRED /. / ATE CL=RE LETTER :SAILED <br /> NAME CF ` <br /> ':v,Lv�roa <br /> _x 23 80 (UCT.xs T)\5/90 17 ,I <br />