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PUBLIC 4EALTH 501VICS/EHVIRCHMENTAL 4EAL•#VISICH <br /> SAN JOACU[4 GATE �a-7-� <br /> [, .T ':CRKSHE:h FCR SITE GCSURE E')ALUATION <br /> [. ISYE=PS CCOEI j <br /> NAME Of FACILITY <br /> TANK [0 . <br /> AOORESSI + <br /> TANK SILT g+ IFUEL TYPE i ,f ' ` <br /> II. GENERAL SITE 4ISTCRY N <br /> IFaciLity Status Code` O�IOec.SoiL cn <br /> Ctl Yesl no <br /> Is dermic current?IYes �NaI (Pentair 3I - - <br /> Vunaer or Tanks at faei l iryI <br /> (Age tar anks(ir avahlaale)i (Type of Tank Steell I"brgtl ISngII Ouall <br /> :([, TANK HISTORY ( <br /> Was iank STORY7lYesl INo, (faired precision test ?IYes I IRai IIf yes, give date(s) <br /> as a repair made to the :tank system? I .N°� IIT Yes• <br /> vhat utas re0airea?I <br /> as aair done under irenee'ian7lYrsi INol Iver_ soiL samples anatyteelyesl INo( RTXEI ITP%-GI ITP%-DI IPb/SBI <br /> 'yce of 'tai lure/discharge) Imtastropnhcl Itong-tenn Learagel I <br /> over.i l l i I unknown I I Other <br /> P/. 2EHCVAL 41 ST0R7 (ATTACH INSPECTICH REPCRT FCR SITE CETAILS/C1LLECT DATA FCR LEACHING POTENTIAL ANALYSIS) <br /> I (Average Annual 7reeipi�ationlA=I ti• I10-u <br /> :Soil Sa+mles Received No (Depth ca Ground Waterl��IRef/Year) ; <br /> Cn-Sice 'aeLL(s) 'I INa( Number b Type) IErrI (Dorm !PwI <br /> Store S Sazrs S Store <br /> C 10 pts C 9 pu C 5 pts <br /> �Oi stance to WeMs) from iank) ft: C if 0 if D it <br /> Z (condition i canai cion R cmdi ti an <br /> V. Site Feature - Leaching "ocertti al Analysis - <br /> is Tet - is .Dec c is met <br /> �J1,� I I >,00 I i5i-,GO I © ►. L°-50,7 <br /> Mini nun Depth ca grourxNater fr® :he Soil SawLe (4mtj V <br /> c gyres in suisurace (apoties to 'oothilts or mountain tar'ffiI r None <br /> 'Jnkna+n I Present: <br /> 410 I 9 I 0 25 ISI 25-La\2 <br /> (Average Annual Precipitation (inches) I <br /> 'Man—lade tZrduits which increase vertimL migration I I Norte I y i Unknown I (Present <br /> f 'eachate (i z septic systeas "tar ter •wells, per+as) 1 <br /> lzz7uxXl Mane (� I AL teas 1 More than <br /> Unicue site features: Recharge ares, Carse soil, nearmy *el Ls. i nnel all'a <br /> COLUMN iOTALTOTAL POINTS 1lbI � 7i i <br /> ;0 or less ( <br /> sa=te 2leJsuLtt: (B T X OR E) .RANGE OF TOTAL POINTSJ49 pts Or mar_ I 67 - ':3 pcs pts <br /> 11c IV A ' sC� 17`� MAXIMUM ALLOYABI._ 3-T-X-? LE'VELS (PON) ;I i0l i01 i0 I 3 I.3 t.I t. .4AV <br /> JiL5 MIND <br /> M 100 10 <br /> sPgPpL•PIP/ e R uLts - D• MAXIMUM ALLOYABLa TPM LEVELS (PPM) DIESEL tNE 100 1040 <br /> 100 <br /> TPH <br /> —If documented soil and/or groom nater cnraadnation is present, do not complete the ing potentiaL <br /> F�TNOTES: <br /> analysis. (i.e., site is cu'r1ftLY an LUT Contamination List far Boit or ground va <br /> i \1 [t death is > 5 ft- and a 25 ft., sere 0 points. If depth c5 ft-, do not use table. <br /> \2 If precipitation is > 40 inches, store 0 points- <br /> \S Levels for 31'XEE are not appiicabte at a TPH conxee+tration of 10 pp, (gewiine) or IOU Fps (diesel)J. ,, (, <br /> VI. STAFF 3ECCWENOATICN/Q)CLUSICN "S*C KID 1, le. (yKa-Cue�r�� to d-4,k- <br /> 1. Are 37X 3 E or TPH Caneentratiaro > AlLahmo/e Leve(s I^e: INa( ST I (h"( 8E_ <br /> 2• Recommend Site Closure 7esI INa( I�lf Yes, Refer to Site Mitigation far _valuation i qD vvp <br /> VII. REVIEW EVALUATtCN - TO 3E CCMPL'+ gT A SUPSEVISOR/SE%ICR S - <br /> C_NGR WITH STAFF .2ECCMMEVOATTCN FCR MOSUREIYESI 1401 IRE RREO i4 SITE .YITTGATiON FOR e/ALLNTIONIYESI IVO, I I <br /> DA"< REFERRED / / )DATE CLOSURE LETTER HAIL.0i / / I <br /> NAME CF I <br /> EVALUATCRI <br /> EH 23 30 (uGTWKSHT)\5/90 <br />