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UCS" 't ...HeE" FCR SS(,E CLOSc.RS =IALUArICA � p <br /> f .�C:�:"T f G r C�'�; GR G �( C.�2')� iS:'E a?S ( � ��✓ G <br /> ss c' .r G� IA <br /> s I.e (,}0� FUEL rTPe <br /> °XAL WE :4IS"CRT <br /> rmi c cucrane? Ifes o ` erni: 3 I - ae i t i cy Scacus CoCe �oe.So i t/T1 Ccne Yes 4a <br /> r of ranks at fac!ti:yI �ge of "anks(11 available) ` I7ype of fark �ceel bc;l I �N t Ouatl <br /> xz iISTCRT <br /> ank tested? fifes I 4a sited -zreeisien :est 1 hes 4oI lit yes, give dace(s) <br /> repair .cede :o :he :ark syscem? �'es ( Na �f yes, what was repaired7 <br /> e^,air done s+der inscecticn2fifes I �Io l dere sail samotes analy_ed? 1:e3 l i o l rX£ ` P3-G l P4.0 b/EDB <br /> of failure/discharge I racascro;hic Itcng-Cera leakage javerfilt I lixikno.rnl iocher: <br /> OVAL AISTCRY (ATTACH (24SPIC7ICN IS?CRr FCR SITE DETAILS/ML:Cr DATA FCR LcACRINc PWENTIAL ANALTSIS) <br /> Sameles tecaived 4:s I + a r �epch :o Gr:crd 'tater I:�Er � of/Tear( �i24 �'� ��verage Arnual Precipicacian 'as SIG 170-ZS <br /> ce VeLL(s) Yes I Ifo I ! fber L Type <br /> S Scare S core S Lcare <br /> nes :a ':elt(s) from Tank I f:; ft; ft C 110 PCs C 9 Pts C pts <br /> 0 �f <br /> 2 �'_ldition x x+d1Cian A Condition <br /> i,e Feature - Leaching Pocenclal Analysis lis .net E is net <br /> Depch :a ;rocs-Bracer from :he Soil Saaple Cfeet) I >100 i-!CO l l 25-50\1 <br /> ores in sucsurfaee (applies: :a foachi lts or :attain areas) ! /�) Nme ( Unkmcun I resent <br /> ge Arrmuat Precipitation (inches) <10 I 9 110-25 �tzzzxzz I ZS-LO\2 <br /> ode :on�ui:s .hick increase vertical nigration l <br /> scha:e Ci.e., septic systems, water welts, yards) ! �� I None I ! Unkno%nresent <br />•e lice feacures: Aechac;e area, coarse soil, near5y wells. I I I I At Less* f are than <br /> /ycxzz:cz None If we I one <br /> CCL!."A TOTALS»),TOTAL POINTS <br />.e tesulc: (S T X CR e) UXGc Of TOTAL POINTS 9 Pts or more I G1 - 43 pcs l 40 pcs or less <br /> V4 - ,,2-pp en7 st'x - <br /> fip"u1/ 3), MUCL".12� ALLCUAR-E 3-r-X LEVELS (P914) 1 150 I <br /> 50 I <br /> 50 .3 17-.1 ' 1. AA\3 <br /> e les =CLINE <br /> I =CLINE /C00 l )OO 10 <br /> N/�L �pyM �1" ALL=BL: TPR LEVELS CPPN) �IESEL 10,0(0 l 1=0 l 100 <br />'OrE"a: "'If documented snit and/or growd water concamirvtion is present, do complete c t0aching Potential <br /> aralysis. (I.e., sic* is currencty on Ucr Coneaminacion List Eor ocrd water.) <br /> \1 If depth is > 5 ft. and < ZS ft., score 7 -4incs. It depth —5 ft., do not use :able. <br /> \2 If Precipitation is > :0 inches, scare 0 Poincs. <br /> \3 levels for 3TXZE are not applicable ac a r94 cancencracicn of )0 ;m (gasoline) or 100 rya Cdieset). <br /> r'F ,2EC:?frENcATIC9/=MuSiCA <br /> Are 3TX L : or TP9 Czmencracions > Attowbte Lnvets �'Tes I o <br /> 2ec_:amerd Site CtosurelYes I o ( �if Yes, 2efer to Sics Aitigacion for Systuacion <br /> YIEU EYALUATICH - TO 3E COtPLBTM 3T A "SAYISCR/S' ICR <br />:R ':1N STAFF .2SCCMC140AT(Cl1 FCR CLOSURE "ESE �EF 2R£0 "0 SITE 4ITICATICN FCR E'IALLiATICR ltSS f 40 <br /> 2EFEt387 i ! / ] =RE LEiTEA NaIL50 <br />'ATCR �� 3 <br /> 130 CUCT:YS:tT)\s/40 <br />