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ADDRESS rACILITY ;: WORKSH •� n SERVICES/E,NvI _ <br /> f— /7 E`7 FOR SITE CLOSURE EYAIUATiL NAL TN DIVISION <br /> TAN <br /> K SIZErr �� 11EEPS <br /> II, G i FUEL TYPE ,. - < -_e is CODE <br /> GENERAL SIT TE HISTORY ! _ J �" �`—' TANK ID f -)C• ' <br /> Is permit Current? Yes L a G)� <br /> No <br /> Numyef of TPermit monka at facility - <br /> Facility Sta[ua Code <br /> III• TANK HISTORY Age of i .�� <br /> +*scff available)IDoc-soil/111V <br /> Cont Yes Was Tank teated7 Yq No Type of lank Steel Fhryt No <br /> Failed Sngl Dust <br /> Was a 'epair precision test 7 Yes <br /> ' made to the tank system] yes Nol <br /> Vas repair done No If J'ea. 4ive date(:) <br /> Or 'er i If yea, what was repaired] <br /> nsPectionllTp No ' <br /> Type of tai lure Vere soil samples <br /> /discharge eat ar1°lY2ld7 Yes <br /> astrophie Long-term <br /> g-Ce No BTXE TPH.D <br /> lN• REJCVAL HISTORY res l°°kBgQ loverfill 7PH•0 <br /> (ATTACH IIISPECT:OX AEPCA7 r unknown other: PC/EDB <br /> FOR SITE DETAILS/COLLEtt <br /> Soil 3a"Otes .Received Yes iNo' DATA FOR LEACHING <br /> 1 OpU to Groad VaterlPOTENTIAL AYSIS) <br /> JeLR(S) Yes IRef/Year <br /> NQ <br /> No ;ML0ber L typel Irr IDomAverage Annual Precipitation Aa <br /> IDis'ance -a Vell(s) from 7arx, ... IPS 14 to-ZS <br /> >• Score <br /> S score S <br /> C <br /> • eft � Pts'0 pts score <br /> f 9 C <br /> /• 3"t "ea-are . Leaching POtentfal Mal is R 0 5 Pts <br /> ys condition f 0 if <br /> •R condition R <br /> 'Minima ;r.th is met E condition <br /> -o groutdwater from the Seil S is aec E <br /> ample (feet) is mac <br /> )700 51-100 <br /> Free- -es 'n subsurface ;atelias to foohills or mountain ares:) 125-50\1 <br /> i None <br /> Average Arraal Preeipitat:on (inches) U�f101^ IPresene <br /> :oDcui <70 9 110.25 I I <br /> Man•.Mace :res <br /> its which increase vert.1cal atgratien xc xtc< 26-40\2 <br /> IDf leaonate :1.e., septic systems, water Wells, ponds) i mox <br /> ( <br /> !Unique si-e 4atures: Recharge area, verso soil, nearby wells. I larkrvAn Present <br /> XX>Ctzzl <br /> i Nana I At it"-. iMore than <br /> one <br /> CCL" T0TAL9»TOTAL POINTS I l <br /> Sample Result: (6 T X OR J RANGE OF TOTAL POINTS 49 Pts or DoreI I ' <br /> 41 - :8 pts 40 pts or less <br /> 31 , X c 9 T X <br /> MlI:IUI ALLOWSLE 3•T-X•E LEVELS (PPM) 11 501 50 50 .3 .3 i.l 1. I NA\3 <br /> SaWIe Result: GASOLINE 1000 100 l 10 <br /> IMAXIMLA AIIOVABIE TPX LEVELS :PPM) <br /> TPM DIESEL 70,x0 low l 100 <br /> e1r>If doctmnd/ <br /> entedsoil aor ground ester contamination is zresent, do COI cothe Leaching potential <br /> FOOTNOTES: analyst'. (J.e., site is arrenCLY on UGT Cantaainetion List for soil or 3r'ou water.) <br /> \1 If depth is , 5 ft. and < 25 ft., score 0 points. If *epth < 5 ft., do not use 'acts. <br /> \Z If prscipitar:on is > :0 inches, sane 0 Points. <br /> .3 Levels for MLE are roc applicaeleat a TPN concentration of 10 ppm (gasoline) or IM ppm (diesel). <br /> .:. srwrr zc��•xevnRr:cx.ar_.nlas <br /> Are 3TX L E or 7A :oraentratioru > Allowable Levels ^es No <br /> > Recomime Site -tosurelYesl IMCI hjf Yes, refer to Site Mitigation for cvatuat:onl <br /> /l:. REVIEW EVALUAT:CN • TD 3E COMPLETED 3T A ZVEAVISOfSENICR <br /> CNCR 'JITN STAFF REC9arE.NDATICM FOR CLOSURE(YES( RDI (REFERRED TO SITE AIT15ATION FOR EVALUATICM!YESI NoI <br /> DATE REFEQAED� ! 1 (DATE CSgIRE _mEA MIIIL�I r — <br /> 'NAME .F <br /> E`IAl:r1SCRl <br /> 1 <br /> cd '3 30 ;U�e,LSxT;�5/9D <br />