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SANlaAOUWTY PUBLIC :1EAL7H SE7VICS/E4VIRCNMEHTAL "!%^ OIVISICH ) v <br />(� / T '.ORKSHEET FOR SITE C/OSURE EVALUATICN (GATE)-7�� <br />]NAME OF r:AC,ICI�:/i[../� �'!� N i�. S L7E7 G'IEi ,yy,1 .�T r!��l •(,-� ISUEoS C'�EI .% R3 / // / �S <br />1 ADORESSi / / O 7 F. �,1' Ci i/(7 �i.FG� Y\LiT 21 /�1, ITANK ID :``�/ / �l� (/fJ— I <br />TANK SIZEI U �1J (FUEL TYPE% <br />[I. 1FNE.RAL SITE HISTCRY <br />I'Is permit current?lyes) Nal (Permit tI 1Facility Sats Cadet 0ee.SeiL/GW Cant) Yes <br />l 1No1 <br />Au ter of Tanks at facility) (Age of 7anks(if availaote)l IType of 7arr4l Steell 1Fbrgtl ISngll OuaLl <br />TANIC N)STCRY <br />vas iank tested7lYes1 <br />INoI <br />IRoi <br />(Failed <br />precision cast ?IYesl <br />INoI <br />Ttf yen, give mce(s)l <br />110-251 <br />':as a repairpence :o :one :ank system7l Yesl 40 <br />vnat was repaired? 11r yes, I <br />':as repair care under inspection? <br />Yes l INat <br />l <br />)were soil saneles analyzed?) YesI <br />INcI <br />18TXE� ITPH-G1 1TPN-01 1Pb/EO81 1 <br />:Yee of fat lur_ldischargel <br />catastrodhicl ilag'cerm leakage) <br />jcw,,-HLLl Iunknovnl <br />Teeter: <br />i`/. REMOVAL HISTCRY (ATTACH IMSPECTICN REPORT :-0R Site CETAILS/CLEC^ TATA FOR LEACIIING POTENTIAL ANALYSIS) <br />. /r4� <br />I7 <br />RecaivedlyesI <br />INoI <br />(Depth t0 Ground water) <br />lRef/Yearl <br />,,(� <br />Average Arcual Precipit3tion)A=114 <br />110-251 <br />'Soil Samples <br />/ <br />Cn-Sita wellCs)I7es <br />jNo1 <br />Mune• 3 -,/pel <br />Itrrj 10aa1 <br />lPuol <br />l <br />S <br />C <br />Score <br />t0 pts <br />S <br />C <br />Score <br />9 pts <br />S <br />C <br />Score <br />5 pts <br />�0+s:anca :a 'let t<s) than 7anKI ft; ft; <br />j <br />0 <br />i <br />° <br />if <br />Condition <br />is WC <br />0 <br />i <br />° <br />i- <br />corCitta <br />is mer <br />C <br />R <br />_ <br />if <br />Cpnditian <br />is set <br />V. Site Feature - Leaching Pocantiat AnatY%is <br />TAinim Oeott :0 3rounaatsr frCl ,he Soil Saaole (fe--U <br />I <br />I >i00 <br />151-100 I <br />25-50\7 <br />IF^attunes in Sucsur,ace (a polio% :p foothills or x stain areas) <br />r� <br />I I (I <br />Nae <br />f <br />l .nuewn l <br />)Present l <br />lAverage Annuat Precipitation (inches) <br />lXz` <br />l <l0 <br />I 9 <br />l 1G-: 1XXX'c=I <br />25-40\2 I <br />'Man -Made cordui is wnich increase ver -I=t migration <br />I i <br />I <br />i "inicraheh <br />Present <br />of leachata (i.a., septic system%, water welts, ands) <br />.None <br />Unique site features: .Recharge arca, parse soil, nearcy 'ills. <br />I <br />At least <br />! <br />More T <br />aXl Norte <br />ane% <br />=a <br />one <br />'r=L GL�'CTA� »TOTAL POINTS <br />V <br />`� I 1 ` <br />I •. <br />' �• <br />_J <br />Samele 7esut:: (S Tr� X OR E) 7ANa OF ICTAL MINTS <br />4.9 pts or acre <br />I -1 - :B pts <br />I :0 pts or less <br />ISE - ll �, �!. <br />3 <br />7 i X I E <br />7' X <br />MAXI"ALLOYABL 3 -T -X-2 I_N@S (PPM) <br />1I <br />50i :ill 50 <br />13 <br />-3 '.3 11.I <br />Sanole Results <br />WSOLINE <br />7000 <br />1 100 <br />l 10 <br />(MAXIMA( ALLOWABLE TPN LEVELS (PPM) <br />"fPH IOIESEL <br />10,100 <br />1 two <br />I 100 <br />PbTNOTES: —If Commented soil and/or ground 'water pntamination is present, da not csctete phe Leaching pctential <br />arm Lysis. (i.e., site is currPubty on =7 Contamination List for soil or around water.) <br />\1 If depth is > 5 ft_ and < 25 ft-, spore 0 points. If depot =i ft., do not use tacLe. <br />j\Z If preeipi cation is > 40 inches, snr- 0 points. <br />U L evets for 3TX&E are roc appticaole at a iPM concert. osis of 10 ppm (gasot irx) or t00 Ren (diesel)- <br />% <br />VI. STAFF 7E" CMMENDATICN/CNCLUSICN '7I<- Q.tej 4, I-'...11l6X4,k-- <br />1. Are 3TX 3 E or TPH Concentration% > Allaweole Levets I"ft ISoi 1 <br />2. .Recammno <br />site C:e Iu Yasl INo' If Yes, .Refer to Site Mitigation far Evalwt5on Al T 6 <br />'III. REVIEW =VALUATION - 7,a 3E CCMPla-T® 3Y A SUPSIVISCR/SEMICR <br />1CONCUR WITH STAFF RECOWENDATICH FCR :OSUREI7ESl N01 IREFERREC TO SI —.E MITIGATION FCR EVALUATION <br />DAT'- REFERRE9 IOAT'c COSURE L_��c3 .WIILMI ! / <br />NAME OF <br />EH 23 80 (L'G.%XSHT <br />