Laserfiche WebLink
SAM 10ACUIN CCUHTYf, 'LIC HEALTH SERVICES/ENVlRCHME!iiAL HEALTH Dr'' "ION [ S <br /> r UCST� kSH£ET FOR SITE CLOSURE EVALUATICM �'E g•7i C <br /> FOF FACILITY �; EPS co 06 <br /> ANIC t0 $ _ <br /> OR£SS <br /> Ir US UEL TYPE LTV\ <br /> 1!. WERAL SITE HISTORY " Q <br /> Is permit current? es o ermit - aeitiry Status Code oe.Soit/ev Cant es o <br /> unbar of Tanks atfacility 4 <br /> e of Tanks(if available) ype of Tank teal begt ngt Oual <br /> III. TAHX HISTORY <br /> as Tank tested? des o ailed precision test ? es o [f yes, <br /> give date(s). / <br /> as a repair made to the tank system? as No f yes, what was repairedT <br /> a repair done under inspectionT es of ere soil samples analyzed? as o TXE PN-c PH-D tr/EDB <br /> ype of faiture/discharge atastrophic s,long-term leakageverfill Hawn they: <br />#V. REMOVAL HtSTORT (ATTACH INSPECTION REPORT FCR SITE DETAILS/COtt•Ecr DATA FOR LEAC14114G POTENTIAL ANALYSIS) <br /> it Samptes Received es a epch to Grotr+d Water S eF/Tear s�: <br /> g verage Annual Precipitation' = 4 0-Z5 ' <br /> -Site Nett(s) es o urber 3 Type Irr )am b S care S core 5 care <br /> i}stance to WeLl(s) from Tank ft; ft; ft C 0 pts C pas CC fpts <br /> O if 0 if <br /> R ondition R condition R anditian <br /> Site Feature - Leach#ng Potential Analysis E s mac E ls met E s mac <br /> �iinimua Depth to groundwater from the Soil SaagLC (fee oi5 1C� <br /> r >toQ t-IQQ 0 Z5.5Q\1 j <br /> xrsc:ures to subsurface (applies to foothilts or mountain areas Yana <br /> Unkrsarn resent <br /> IAvc-age Amuat Precipitation (inches) Kxxxxx e1Q 10-Z5 xxxxxx 26-40\Z <br /> 6*~&'de conduits 1,hich increase vertical migration resent <br /> I te3chate (i.e., septic sysCems, water wefts, ponds) IL Nave Unknown <br /> ore than <br /> A[ l l <br /> ique site features: Recharge area, coarse soil; nearby Wells. e <br /> ' IF one <br /> xxxx None we <br /> COL" TOTALS>>>70TAL.P014TS 20 D 3 <br /> am <br /> RANGE OF TOTAL POINTS 9 pis or ore 41 - 4a pts 40 pts or <br /> pte Result: (8 T X OR E) toss <br /> :m <br /> 3 <br /> TTX E B XEMAXif11l1 ALLOt1A8tE 8-i•X-E LEVELS (PPM50 .3 J.T <br /> 3 1. t. NAA\3 <br /> ample Result: <br /> SALINEFIE <br /> 100 Cn <br /> I" ALLcwABLE TPH LEVELS (PPM) 1Q0 <br /> TPR <br /> tESEL 5000 <br /> oOTMOTES: *"'If doeunenced sail and/or ground water contamination is present, do not complete the teaching pocenciaL <br /> analysis. (t.e., site is currently on ULT Contamination List for soil or 'ground: water.) <br /> \1 if depth is > 5 ft. andl < Z5 ft., score 0 points. if depth <=5 ft., do not use table. <br /> \2 if precipitation is > 40 inches, score O.points. <br /> \,3 Levels for 3TXSE are not applicable at a TPH concentration of 10 ppm (gasoline} or 1Q0 ppm (dieseE). <br /> !. STAFF RECCMENDATION/CCNCLUSIO)1 <br /> 1. Are 3TX d< E or TAH Concentrations > Atlowabie Levels Yes <br /> 2. Recomnerd Site Ctost es o If Yes, Refer tp Site Mitigation for Evaluation <br /> '1. REVIEW EVALUATION - TO SE LCMPtETED aY A SUPERVISOR/SERICR <br /> 'I1R WITH STAFF RECCirhE40ATI0H FOR CLOSURE ES 0 EFERRED TO SITE iITtCATiCN FOR ~VALUATION E3 0 <br /> v <br /> E REFERRED / / ATE CLOSURE LETTER MAILED f <br /> L'JA)4C- 7FATOR <br /> CH 23 aG (UGTWXSHT 5/90 <br />