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SAN :CACUIX Cad-lUBL:C HEALTH S--cRVICES/ENVIRCNNENTAL HEALTISICN <br /> UCST '.w;ZHE--T FOR SITE CLOSURE VIALUATICN OAT-cI G p <br /> TF FAC'.LI TY 1— (l=�G ���•4..1� — A UG-t�-- �1 I SWEEPS C' e z3 - t p�IO C, <br /> ADDR£3S .yOS l f\l i�v\S��'v 1�0;1,: S—� <br /> cKT LA I TANK 10 3l 3q - <br /> :NK SICEIICi U L U IFUEL 7PEI C—,, <br /> I . <br /> Cc4E.RAL SITE :it ST CRT <br /> :s permit currentTIYea INoI Persil !) - I C ye <br /> ' Facility Status aCel U) Doc.Soi l/CJ CmtlYea IXoIX <br /> .Numer of Tanks at facility) (Age of Tanks(if avaiLable)I f,5 IType of TanklSteell Fbrgl) SngLI k 0uall <br /> :?I. TAAK 31STCRY <br /> Vas Tank tested2l Yeal X IN-1 ' (Failed precision test T 1.Yesl INo! k' IIf yes, give date(s) <br /> vas 3 repair made to the tank system?IYes I Mo X IIf yes, what vas repeiredTl <br /> vas repair done under inspectim7l Tes INoI X (Vere sail samples aralyzedtl Yes INoI BTXEI (TP4-GI ITPH-OI lPb/EDB( <br /> ,Type Of failure/dtsaharge! IcatastrophicI Ilcrn-taro Leakage averfilll (unknown) other: <br /> V. M*VAL 41STCRY (ATTAC4 INSPECTION 2£PC2T FOR SITE DETAILS/COLLECT DATA FOR LEAC31MG POTENTIAL AXALTSIS) <br /> (Soil Samples Received Yes! INTI 0epth to :.rood Yaterl I2ef/Yaarl (Average Arrsal PrecipitactmlA-I14 I10-25 <br /> ICn-Site vet L(s)ITesI INoI (Number i Typel IIrrI loam Pub , <br /> 5 Scare S Score 5 Sears <br /> Oistsree to well($) from Tankl !t; ft; ft C i0 pcs C 9 pts C 5 pts <br /> D if 0 if 0 if <br /> R cord{lima 2 cord[tim 2 ccrditim <br /> {V. Site Feature Leaching Potential Analysis _ is net -e is act is met <br /> INinian Depth to -groundwater from the Sail Sample (feet) I I >100 I I51-100 15 <br /> J C' I 25-50\1 <br /> 1 Fr3ctBres in subsurface CappU m to foothi LLs or mauocain areas) i D Nara I r I Unknosmt l (present <br /> Average Arsral Precipitation (ir"Ies) sssxtsl 110 I 9 I 10-25 Ix===l Z6-40\2 <br /> ;Nan-.1ade conduits vhic's increase vernal aigratim <br /> ;,Of '.44C.'14 cc (I.e., septic systems, water kits, par.'s) I Mane I ul-kx rs Prtsene <br /> �UnicLe site features: 2edlarge area, :parse soil, nearby walls. I At Leastl More than <br /> Nae ane Ona <br /> I <br /> lCCLIA01 TOTALS»>TOTAL POINTS l V Q i S 2y <br /> Samcle pAie``sult: (3 T X 02 9 iAMGE Of TOTAL PCIMTS 49 pts or mare I 41 - 48 pcs I 40 pts or Less <br /> `V✓ NAXIXX ALLOWABLE 3-T-X-E LEVELS (PPM) t 50I SOI 50 I .3 .3 t. e. U\3 <br /> Sample Rasult: GASOLINE 1000 100 I 10 <br /> MAXI)e:)p ALLOWABLE TP4 LML 5 (PPM) <br /> `V TpN DIESEL 10,060 I lam I 100 <br /> FOOTYCT£S: —if documented soil and(or graerd nater :mtamiratim is present, do not cmolats the LesViinq potential <br /> arvlysis. Cf.*., site is currently On UGT Cmtminatim List for soil or ground water.) <br /> \1 If dept.? is > 5 ft. was < 25 ft., score O points. If depth o5 ft., do rat '.=e tab(*. <br /> \2 1; precipitacim is > 40 inches, score 0 points. <br /> U Lavels for 3TXSE are not applicable at a TP4 concentration of 10 ppm Cgasolirw) or ICO = (dieseU. <br /> '11. i;AFF RECCMMEHOATICM/C=C'USICX <br /> Are 3TX 4 E Or TPH CmC Cradcra > Allowable levels I-TesI INoI <br /> { ?. iecsmerd Siva Clamor{7nI IMa{ I It yet, icier ;o Site Xt ii 9acfm for 3valuationl <br /> '!II_ WREV 5ALUATIC1 . TO 3E CCMPLZTE] 3T A WERVI SCR/ VILA <br /> 9 'IITH STAFF tEC=Q(E.V0AT:CV FCX LOSUREIYESI r INCL (REFEU0 TO SITE XITIGATICX FCR ZvALLATICXITSSj INOI I <br /> EF-ERRED( / / (DATE C. m NAILUI / / I <br /> INANE .F �- CLt-�7 <br /> IALUATC2I <br /> Am <br /> ;:i Z3 3C CUL=SHT)\5/90 <br />