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SAN .'OAQI IN coumrY PUBLIC .4E1L714 SE.RVICSS/ENVIRCHMENTAL HEALTH OIVISICH <br /> 1• 7 XRKSHEET :CR SITE CLOSURE VALUATION <br /> (NAME OF FACILITY �4NLO.0 ✓fL�, � �C` TS E-:'S CODE! a 3 I5 3 Q <br /> ACCRESS! 6X O <br /> ��/-u.' U�1%�'^✓�i�i V <br /> TANK SIZEIIIiUEL SEI � <br /> [I. ZENE.UL SITE HISTORY <br /> rts -emit current?IYesIX INaI IPermii .'I - IFacility Tans CadelQA (Dae.Sail/GI CantI7e5I INaI <br /> 4ucer of ranks at facility+ % ;Age of ianks(if avai lable)I �c/J4e (Type of rankl SceellI Fb17tj SngII ouall <br /> TANK HISTORY / <br /> Uas lank cested?IYes Nal IFaited precision test ?lyesI INoI IIf yes, Sive dace(s)I <br /> -':as a r-pair' mala to -he tall✓ SWZW?l Yes 40I If yes, what was repaired!I L �D Ci,,j•l�L�-CF- 4, <br /> was :=air done .alder inspectimllYes l INai Were soil sales analyzeo?Iyes I INoI RTXEI ITPH,I TPH-OI Ipwasl <br /> 'yce of failure/discnargel Iratastrooeicl Ilong-cenm Leakage) Ia.,fiLL1 Iuiow j Iacner: <br /> iV. 2EACVAL :HISTORY CATTAC.4 INSPECTION RE33ORT .MR -alT-e DETAILS/COLL'CT DATA FOR I EAC41MG POTEE4TIAL ANALYSIS) <br /> Soit Satteles ReceivedlYesl INoI loepch to ;rorid Vaterl IRef/7ea1l (Average Annual Preeipi taLian�A=I 14 I10-251 <br /> ICn-Site 'VeLL(s)IYesI INoI INtmber 1. Typel Err! Iowa IPes� <br /> S Score S Score i Score <br /> )Cis;once to 4elt(s) fraw TartKl ft: C 10 pts C 9 pu C 5 pts <br /> 0 if C if a if <br /> .i ca+ai cion .R condi ci on 3 condi cion <br /> V. Site Feature - Leaching PotatciaL Analysis C is act c is .trr C is at <br /> Mrnimm Depth to 3rouncuarer Tram :.ne Soil Saocle Cfeet) .;Cc I 151-10a I 25-10\i <br /> V <br /> IF-.ctures in subsurface (applies to foothills or :curtain areas) Noce I I Unknown IPresertt <br /> iAversge Annual Precipitation (inChea) I)cocax1 eta I 9 I 10-25 IppooRI 5-40\Z I <br /> Man-:Made conduits which increase vOmi=L sigmti an <br /> of Leachate (i.e., septic systems, water 'zits, -errs) I I Hone ` i Jnknowrt i Present <br /> Unicue site features: Recrarge ares, coarse soil, nmrny elLs. I I At least) Mare --tan <br /> :OOltax <br /> 4— ores one <br /> COLUMN 70TAL911TOTAL POINTS ( - <br /> Sm ie result: (S r X OR E) UNGE OF TOTAL POINTS 149 prs or mor-_ I - 4z pts ass <br /> nIyI I tU l� _ <br /> I' A LLQ — NAXIHIMI ALLLYANLE 3-r-X-_ LEVELS (PPM) ;f iCI i01 <br /> 50 3 I-3 1. NAV <br /> i <br /> SancLe result' GASOLINE 1000 I 100 I t0 <br /> -•K X61-T-,- T IS MAXIM[al ALLOAAn: i7N LEVELS (PPM) <br /> �. TPN!7 DIESEL 10,coo I 1= I 100 <br /> FOOTNOTES: —If doaaoented suit and/or 3raurd "car concmination is prrsenc, do rut cosclete the leaching tel <br /> analysis. (i.e., site is arrtrtcty on UV Commination List for soil ar ground water.) <br /> \1 If depth is > i fc. and < 25 ft., sore 0 *n=. [f deP= =S ft., do not awe able. <br /> \Z if precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXSE are not applicable at a rPH r ncerttration of t0 ops (gasoline) a 100 Pao (dieset). <br /> VI. STAFF RECCMENDATION/CCNC ISICM !se� /✓p <br /> I. Are 3TX 3 E or rPM Cmntratios > AL towable Levels I-Yes l INoI I <br /> al "if Yes, refer m Sita Mitigation <br /> Z. .2eca mKnd rite CtasurnlTes Nar Svaluatio <br /> VII. 2EVIEH EVALUATION - TO 3E C7[PLETED 3T A SlAwRVISCR/SENICR <br /> ! IIGR 'KITH STAFF IrCCMMEWATTU FCR CL09WEIYESI INaI IREi•EERRED M SI�c .MITIGATTON FOR EMLUATIONIYESI INaI I 1 <br /> CA72 2EFZREDI / / IRATE C.CSURE L-Tc.2 4AILE7I / / I <br /> NAME OF I <br /> VALUATCRI <br /> 293 30 CUGTYKSHT)\5/9C _ <br />