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SAN .:CACUIN OTY ?USUC HEALTH Taviai/EVVIRCMMENTAL 1rVISiCN <br /> L• ..w, :CRKSHE71 :MR SI`c =CSURE VALUATICH ICATEi /��7� Q �y <br /> NAME OF :AC:LII! I� — <br /> sS �E� � 7— ll i <br /> IACCRESSI <br /> I p,���) I i:.NK i0 <br /> SANK -SISI PUv �, IMEL tYPE1 ���Il Q. <br /> !I. :ZNE.ZAL SITE HISTORY <br /> Its :emit =rrent?iyeslx INaI IPefaic ;I - IFaciliy Scarfs C-.F.eiO,�IOae_Sai l/6t Call as <br /> Na <br /> �Aumcer of ranks aract;ry awacteJ I I <br /> I � IAqe or ,ancs(if il <br /> I ' Ype ar �ankl SceeLl IFtr�tl ISng( Owl <br /> :rr. TANK HISTORY <br /> Was rank casree7I Yesl IMCI IFai Led precision :ast ?I Teel INaI I(f Yes, live aatmw <br /> ':as a repair wee :o We -m* sn-,=?iYe=I No IIf yes, •a c was mai reC7l <br /> ':as :r-air cone unser insoec::rnl l Yesi INaIMere ;oil sa®las anatyreelyesl INE; Ig,:EI ITPN-6I ITPM JI IPb/OB) I <br /> rvpe of fai Lure/disciargei Iatas::oeniel ILonq-^.era leakage; Iaverillj Iurvaawll �°c-er; <br /> i`/. IE-.OVAL HISTCRY (ATTAm LNSP�—,Jcm iEcORT FOR 3[is 1ET _L- CATIA FOR LAMING MrcVTTAL ANAL!SIS) <br /> Soil iampies iecelvetliYeslINai IOeisCt a Graune ':ara•I IRef/'•'earI IAwr3ge Annual aresi pi tarianiA=i 1L I10-ZSI <br /> ICn-sire Veil(s)iYesl INaI Amer 7. ypel rrrl I°m'i IPS± <br /> !O;s:ance :0 vell(s) from TanKI c ITp S 9�ti I C Scare <br /> 'i <br /> 0 lif C if I 0 if <br /> i clef cies R oni:ion ; eaidi tion <br /> iV. 3i to Feature - Leadtinq ?otaicfal Analysis ifs .met is mer I <br /> Minimum aeprII :0 3rouns arw fr® Cee Sail saaole (feetl I I x100 i 151-iC0 I Ze_.-ia\i <br /> IF^0c-4res in sucsur=ace (aepties rm foetaitls or masirain areas) I He �I I I Ink:tawi � IPr�errc <br /> Average Annual ?rtcipizacan (inctes) jxxxij e10 I 9 I 10 IX:OC.7rRI S-.a\Z <br /> ;.Van-Race Ccn=irs '+hi= fr=re Ae ver-'et migntiaai I <br /> :of leadtare (i.e., septic system¢, voter •aetls, Rocs) <br /> van, I Jnkrawi I (Present <br /> !Unique site features: .Yel--m area, cane soi L, nary welts. I I <br /> l�I Home <br /> � f I AL ease! More avian <br /> one one <br /> CCL:71N TGTALD»TOTAL ?DINTS <br /> i5aam:Lee I UL-: (S T X OR =) .uma 7F -mm ,0cs ar .mr_ I 1:1 63 Ks I :0 pu or less <br /> I.TkAS NpX ( 2 3 T X <br /> NAXIMaI ALtauaet` 3-T-X-? L_cVE'S (PPM) 1 � fat ;o"O I .S �•� I i.� 1. I <br /> Sanule Result- <br /> Neu <br /> 7 Ka N QMH MIMDI Aa r MA8 c TPR LELS VE (PPM] =CLINE 1000 leo I 1 <br /> LX0 <br /> IOIESc_ I 10,Cd0 I lam I ta0 <br /> r.CTNOT'es: f GaOmciced sail and/or• --meld "rer =,cm mrion is present, Ce not etaolets --to Lam=ing potamiat <br /> analysis- (f.e., site is ==qtly on W, Cataminacfan List far sail ar, grand aeer.1 <br /> \1 If is > S ft. and < 3 ft., ;ere a p0ins. If a I ft_, do not use caete. <br /> \Z If arecdpivarian is > lC Indies, sere 0 paints. <br /> \3 1e eis for arae are r= app;icaole at a TPR oleate-ar'an of TO e1Fm (gasal inn) cr TOO pm (Cfeset). <br /> STAFF REi."N.MEVOATICN/CCNC.r)STCR <br /> Are 3TX 3 E or TPM Cxw=ntr3Vla > AltcwmcLe Levels I^,esf INo� <br /> .iecallm Site Clasurel Yesl IN*!>(�?If Yes, .tefer :0 sire Mitfgarien far =vatuarf ori <br /> 2E'/f ESI --/ALUATTC.V r0 3E 01PLTJ 3Y A 4IDE7YISCR,Sa,CR <br /> )CJR VITR STAFF lEC=memrTcx Fg7t ^nOa1FlYESI iNal IRE REO a'i.c <br /> MIT-,QT-,Cm .=CR :'(AL:)ATTCNI7ESi INOI I I <br /> IGATE C.CSURE <br /> OF <br /> )ATCR I <br /> 30 (UG,WKSH7)\5/9a <br />