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---• ----+» �...+.. rwwa.. WSALIR 4oR.&w.e41CXv11XMPWmJAL W-AL7N DIVISION <br /> UW; -`WMT FOR SITE CLOSURE EVALUATION DATE 7— — <br /> AM OF FACILITY 60S CODE <br /> —' —" <br /> -,Was ,., , TANK ID R 3 •ate 3 - <br /> TANK SIZE1 550 tis<L TY►E <br /> . GENERAL tin NI <br /> K <br /> Is permit current t Yes NoPewit Facility Status Code Ooe.Soit/GW Cont Yea No <br /> Number of Tanks at facility Age of Tants(if available) Type of Tank stooll Ift"ti IsnotlOval <br /> Oval <br /> . TANK N I STORY <br /> Was Tank rated? Yes failed precision tat T Yes No If yes, give date(s) <br /> Was a repair made to the tw* system'! Yes No If yes, what was repairom <br /> Was repair done oder inspection? Yes No Were soil motes uslysed? Yes lN,jr <br /> NTXE TPN.G IPM-01 Pb/EDg <br /> Type of faitwrydisdwarge catastrophic tong-tan leakage overHil uknown other: <br /> I. RENWAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACNING POTENTIAL ANALYSIS) <br /> ;Soil Samples Received Yom No oopth to Ground Water Ref/Ytar ; Avers" /Wesal Precipitation Ai ti 10-25 <br /> On-Site Watt(S) Yes No I Number i Typel Irr Dom Pub <br /> ! Score S Score S Scam <br /> Distance to Welt(s) from Tank -125,_ft; ft; ft C 10 pts C 9 pts C S pts <br /> 0 1f 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - LeaehirM Potential Analysis E is met E is met E is met <br /> Minimal Depth to groundwater from the Soit sample (fe 056— 1 jj 1100 51-100 S 23-30\1 <br /> Fractures in suim fee* (applies to foothills or mountain areas) C ) None Unknown Present <br /> Average Annual Precipitation (intdwes) X=oun <10 4 10-23 xxxmoou 26-40\Z <br /> Man-Made conduits which increase vertical migration <br /> Of leschate (1.e., septic systems, water wells, ponds) None tAknown 5 Present <br /> Unique site features: Recharge was, coarse soil, nearby wells. n At toast More than <br /> xxx)= Nona Ctone one <br /> COLD M TOTALO"TOTAL POINTS 16 + ) J • (j"� ' 3on <br /> Sample Result: (g T X It ). RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> Bx'•i� S i T X E t T X E <br /> D�Y •OI} MAXIOM ALLOWNLE N-T-X-E LEVELS (PPN) 1 SO S0 SO .3 .3 1. 1. U\3 ` <br /> Sampis_R*mtt: GASOLINE 1000 100 10 <br /> '(■x`V��� 1J MAXIMM ALLWASLE TPN LEVELS (PPN) <br /> TPN 0tESEL 10,000 1000 100 <br /> FOOTNOTES: ***If documented soil and/or ground water contaminetion is present, do not camptete the leaching potential <br /> "tysis. (1.e., site Is currently an tXT Contamination List for soil or ground water.) <br /> \1 If depth is 1 S ft. and < 23 ft., score 0 points. If depth aS ft., do not use table. <br /> \2 If precipitation is 1 40 1 m , snare 0 points. <br /> \3 Levels for sTxU are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (dissel). <br /> Vt. STAFF RECOM ENCATION/CONCLUSION <br /> 1. Are SYX i E or TPN Concentrations 1 Allowable Levels 'fes No <br /> 2. AwAm mnd site Closure Yes No if Yes, Refer to site Mitigation far Evaluation <br /> Vit. REVIEW EVALUATION - TO NE CONKET® IT A SUPERVISWJUNIOR <br /> F <br /> UR WITN STAFF RECOMEWATION FOR CLOOM YES REFERED TO SITE MITIGATION FOR EVALUATION YES 110 <br /> REFERRED / ! -t, DATE CLOT M LETTER NAMED OF <br /> UATOR <br /> EN 23 80 CUGTWKSNT)\5/90 <br />