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I <br /> wra ►rrurvl Vqtq <br /> SAM .:CACUM CC,U4TT Pf4EALN Sc'3V1C_S/EYYI2C4MEVrAL 4EALTH O(V f I II. <br /> UCST .t r FCR Sir;- CLQSL'RE ,',VAL'JArXN ni DA 174 <br /> I <br /> ARK 10 Y - <br /> i <br /> slz��T : Don �L TYPE <br />..UL SITE ;3ISTC <br /> ar <br />^-si: eurrentT files a ermit A - aeilicy Status Code oc.Sail/GN Cast ss �ea <br /> of ranks at facility iitge of ranks(if available) I ype of rani¢ teal iF'srgl ngl Oual <br /> IX YISTCRY <br /> I nk tested? ; es o ailed Precision :est 7 es a alf yes, give dates) <br /> repair made to the :ark system? 1 es Yo f yes, what was repaired? <br />°pair done =-x*r inspection] iYes to ere soiL samples analyzed? Yes a TXE PH-G PH-O b!E?8 <br /> If faiI.uretdIscharge aCA$traphie long-term leakage verfilL I �ICnCmnthe <br />[VAL M STCRT CATTACI INSPE_TICH RSPCRT FCR SITE DETAILS/COLLECT WA FCR L:A01%1C POTENTIAL ANALTSIS) <br /> iamoles .Received i es a epch to Grated 'later I of/Tear ;�11�/�lverage Arnual Precipitation = [t4, 0-Z5 <br />;e wet ls) IYes a i umber L TyFe Iter as I to <br /> S core S care Scare <br /> Hca to Wett(s) from Tank ft; ft; ft C 0 pts C pts C pts <br /> Q pf 0 if 0 ,f <br /> i Condition it mdition R �orsr:icion <br />'te Feature - Leaching Potential Analysis - his ret E is met Es net <br /> m Depth to graLrdwater Iran :he Soil Same tfeet) >140 53"140 :5-54\i <br /> gyres in subsurface (applies to foachills or aamcain areas) IKane I Unknown resent <br />'.e Arnuai Precipitation (inches) <10 9 } 10-25 xs;ctsx 125-40\2 <br /> de conduits .hick increase vertical migration <br /> chat° (i.e., septic systems, water welts, panels) Kane Unkm%n rssent . <br /> features: Recharge area, coarse sail, near5y urns. At least Aare than <br /> za; Kone ane <br /> CCL 201 TOT.ILS»>TOTAL POINTS I ; <br /> Result- (S T X CR :) ?AXGc OF TOTAL POINTS 9 pts or more I 41 - 4a`pes 40 PCs or Les <br /> JT 1 <br /> 4AXi.wLm ALL=8L! 3-f-X-_ LEVELS (PPM) I 30 50 150 .3 .3 '1. ^. NA\3 <br /> Result: ✓i (LIN$ 100Q 100 10 <br /> INIRI ALLCVA8U TPH LEVELS CPPN) <br />(Vcc> TPg �f fE5'cL SQ,000 I ICOO lOq <br /> r_S: ­If doccsnenced sail arse'/or gr uid water contamination is present, do not complete the leaching tial <br /> aralysis. (I.e_, site is currently on UGr Contamination List for sail or grad water.) <br /> \I If depth is > 5 Jr. and t 25 ft., scare 0 points. if depth <_i ft., do Mat use :4ble- <br /> \2 If Freeipicacian is > 40 inches, scare 0 points. <br /> \3 levels for 3TXE5 are not applicable at a TPH caneeneracien.of 10 ppm (gasoline) or 1.00 ppm Cdiesel)- <br /> r" RECCf4fEKOATIC:NlCCPtt:LJSIQII - <br /> re 3IX 1. : or TP11 Concentrations > Allowable Levels Yes I a <br /> r_nmmrd Site Ciasure17es �l0 1 If Tesr Refer to Site Mitigation for Evaluation <br /> Ic'J EVALUATICN - TO 3E C04PLETE'D 3T A 5L'PE2VISCR/SzmIC1t <br /> 1 'JUN STAFF RECCIUMENOATICN rCR CLOSURE i.'Sa � }IO I �VSUEO TO SITE MITICAIICA FGR VIALUATM) �ES <br />!EF;3REa I ! / ATE =5.IRE .VrEZ :'AIL_? ! <br />;F <br /> 6rC2 ' <br /> ao (ucr:Ysxr)�5l5a <br />