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SAN :CACUIM =WrY .MZL'C PEAL-.H Sc-<VICS/EiVIRCNNEYTAL 3EAUH CCVISICN <br /> f. "WORKSHEET POR Si,. GCSMR,E�_IALUATIQN IOATEI Z�)� % <br /> !NAME :F 1ACl Lf i. <br /> IAccREis� <br /> s(cyCC rhv G�)x ITANK m (:I/� �j - /5ff- _06, <br /> (TANK SIiEIX 000 IFU£L iYPE1 Jv--�1''I <br /> 7 <br /> P Oma CF-7 <br /> fI. CdERAI 31"EHISTCRY <br /> F Is :ermit clrrenc7i Yesl X INC; Perait Faci Llry Stats Gael Q,.„, JOee-Sail/C1 C�scl7esl INeI <br /> .Water of Tanks at ?aeiLiryl 7 iAge of ianu(if avai laixle)i / Hype Ile Tani'Steell IPargl' ISn9ll Ouall <br /> -ANK HISTCRY <br /> Vas Tank :e52ed7lTes xoi lFai led pr_cisim tes: ?IYes� IMo i[f yes, give dace(s)I <br /> as a repair made to "te mnlc sy=aW Yml .Nei I[f Yes, wet aas r�ai raCll l <br /> ,as repair done . er insoecc4m7{Tml Imai lVare soil sam/es analyzea71`.esl INa{ lBTxEi ITPH-;I ITPR]l IPC/D8l <br /> . e of rai lure/discnargel Ioancroonicl Ilasg-term lmka9e) lever�i 111 Iadxeaynl lacier: <br /> iV. RE:KWAL HISTCRY (A77AC4 INSP=--,ION RESORT ,=QR SIT-c 1E7AILS/CQLL:C7 DATA FM GLEAMING POrERTIAL AMALYSSS) <br /> SuiL Sales Received{Yesl INal ICep= :s Z OLM 'Wacerl IRer/YearlAverage A.L 7recipiacimlA3l!6 10-S <br /> i <br /> Cn-lite 'Well(s)IYesl INai NtaDer i TYPeI llrrl 13=1 Pest <br /> 'a Sere S San i Sere <br /> �Oistance to 'WeLI(s) frw TanK) C 10 PCs C 9 ass C 5 pts <br /> Q it Q f Q if <br /> Z C31di t:m R CaEt tim Z C�IditiOn <br /> V. Site Feu <br /> atre - Leae4inq FatertCfal Analysis E is met l = is met i _ is mar <br /> Hinirtaa 0mtt to gracasoratar fstm cte Sail Saaele (feet) I i >10O I 151-iC0 I i %-:0\t <br /> �=^:c_:res in sucsur.""ace (acptia :p faos7tills or mountain ares.) I i Vase l tkap:mr, l Ipreserrc <br /> I' <br /> IAver3ge Ann. L 2rxioitaciat (inc:es) IxmGtzl <IO I 9 I IO-%3 Izucaecl 3-<a\2 <br /> '.Man-13de oenduits +nit's inG+.e.e ver^ot ai9nt'.m <br /> of fasciate (i a., septic sysce>a, vatar velAs, xnes) I I .Vorse i h+iroKt I IPresertc <br /> Unicue site features: .ie=arge arm, cane sci L, near:.y 'xlts. At less: More •,':an <br /> lzcemcl .Nae I mei I me <br /> CQLL74N 707AL9»TOTAL FAINTS - <br /> Saaa:ie 2esul (3 7 X m ?) RAN(-e OF TQTAL POINTSiL9 ars or mom I 4. - SS pu I :Q pas or less i <br /> sP� k�a N1J3 X 3 X <br /> MXr" AL ZMI.9 3-T-(-= t--VV-S (PPM), t, i0l i0` SQ � I_3 I j ; NAV <br /> Sancta Resul-• GASCL:AE 1000 ?00 IO <br /> `SP OR hT A �I r?a+ `FD MAXI" ALLOWABLEc 7N Lc-VELS (PPM) DIESc'L 10,000 I 1000 l 00 <br /> ? <br /> FOOTNOTES: —'.f da-'^a^rad mil and/or ground ®car entad micron is present, m n= ®lace -te Lmc:tinq petasc:ai <br /> ualysis_ (i.e., site, !s currvntty as UGi Canaminatim List far mil or jr-lyd vecer-) <br /> \i tf Cie= is > i ft_ and < 25 ft_, scop 0 *n s- If timet Qi ft-, do not ;tie eaale_ <br /> i \Z If precpttatim is > (O irh=W. sora 0 points_ <br /> i \3 Lavets far 3TXXE are me appG=Le at a TPN convrcnr'm of 10 ;pe (gasoline) or Ma 312 <br /> n(/dieset)_ ! 'j <br /> VI. S AFF RE"'MMEVOATICN/=CUSICM lS fo(-K p () /Q�� <br /> 1. Are 3TX 3 E or -PH Csanenciana > Al Lauecte Lavels I^nl No <br /> "•l�" S fiL� <br /> ?. tecamrend Sire C:asunlTesl INoI stf Yd, Refer to Site Nitiq;mon far =valuacf ml <br /> Vii. REVIEW EVALUATiCN - i0 3E =W'--M 3T A UW'RVISCR/SE!)IClt <br /> C)C)R WITH STAFF Lr' EMCATTCN FOR .CLO&RE{YES{ INai jmm-mm m sz—,z .'4mmanam .zu E/ALWT:CMIYESI iNOi <br /> i <br /> OA.. REFEREOI / / 'CATE CLCMAE L77E4 .'MILMI / / { <br /> NAME OF <br /> EVALUATOR I <br /> 3H 3 3a (UG7wKsmT)\5/9C <br />