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SAN XACU[N CCUNTT HEALTH ScRVICES1SMVI?CN:MENTAL HEALTH 01V I <br /> 'f R - A rE <br /> UGSi +t. 'EF FCR SITE CLOSURE _VALUAFICM � <br /> .• <br /> 'rE CF FACILITY IA1,0 <br /> OR£ss I p ' I ANX 10 s <br /> WX SIZE USL r7FE <br /> GENERAL SIE aI5 LCqf <br /> RR <br /> ,Wmit current? Res o ermic S - aeitIcy Status Code oc.SoII/CW Cont es o <br /> iter of Tanks at facility ge of Tanks(it available) IType of Tank tee) brgt nqt 1 Ova! <br /> rANX HISTCRY <br /> S Tank tesce47 Hes a ailed preeisien test T es o If }res, give date(s) <br /> S a repair made to Che Cank system? es No f yes, what was repair ed? <br /> s repair done under inspection? # es o ere snit samptes analy.ed7 es o TXE PH-C,l PH-0 tr1SO8 1 <br /> :e of failure/diseharge acastrophie tang-cera Leakage verfitt n cher: <br /> t.MVAL NtSTORY (ATTACY INSPECTION REPORT FOR SITE DETAILS/CCLLECT DATA FOR LEACHING POTENTIAL ANALTS(S) <br /> it Samptes Received es a epth to Croird 'later verage Arnual Precipitation 14 0-25 <br /> -Site Ve!!(s) Hes a unber L Type Irr '�an <br /> S Score S car_ S core <br /> stance to :'elt(s) frac Tank ft; ft; ft C to pts C Pts C Pts <br /> 0 f O if 0 f , <br /> t ondition R mditIon R ondition <br /> Site Feature - Leacying Potential Analysis E is ret E is met E -s met <br /> Titan 0epch to graudwater from the-Snit Saapte (fret) >100 1-100 f �j 25.50\1 <br /> tctures in subsurface Capplics to foothills or mourstain areas) None Unknown resent <br /> !rage AmuaL Precipitation (inches) KXXXXX <tO 9 10-25 xxxxxx 25-40\2 <br /> t-made conduits uh ich increase vertical migration <br /> Leachate (i.e., septic systms, crater wells, ponds) None Unknown resent <br /> que site features: Recharge area, coarse snit, nearby wells. I �-y At teas: are than <br /> xxxx Mane 7 one i are <br /> CGLUM TOTALS? TOTAL PO[NTS * �+ <br /> ble Zesu�ittt (3 T X OR E) RAND OF TOTAL POINTS 9 PCs or more /_112 - 4a pts �� 40 pts or less <br /> T X "e f; T I X E <br /> MAXI.". ALLCWASL= 3-T -X-E LEVELS (PPM) 1 50 150 5o .3 .3 1. 1. NA\3 <br /> ipLe Result: i MJM ' CLINE 1000 100 10 <br /> /'�6�8 TFH IIAXIALLCS:ABLE TPH LEVELS (PPM) IESEL 10,000 1000 100 <br /> 1TNOTES: ­If f documented salt and/or growA water contamination is present, do _ccep the teaching potential <br /> aretysis. Cf.*., site is currently on UCT Contamination List for sail or grocr,d water-) <br /> \1 If depth is > 5 ft, and < 25 ft., scare 0 points. If depth <=5 ft., do not use table, <br /> \2 1f precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TUE are not appticabte at a TPH concentration of 10 ppm (gasoline) or 100 -Vn (dieset). <br /> rAff AECCWE.WATICN/CCFIC.US[ON <br /> Are 3TX L e or TPH Concentrations > Altawable Levels Yes o <br /> Zeccnmerd Site Closure eseo If Yes, Refer to Site Mitigation for Evaluation r <br /> ,ZEV1-e'1 EVALUATICN - TO 3E CCHPUTED 3T A SL'PE2VISCR/SEVICR <br /> HC,R '11TH STAFF 2ECCH1!tNOAT[CN FCR CLOSURE �1E3 0 EFEMEb TO SITE m1TIGATICH FOR EVALUATICN fes 0 <br /> _ .t_F£2RE0 ATE CLOSURE LETTER AMD f % <br /> .c 7f <br /> ILUATCR <br /> 23 ao (UGi%6%SHT1%5190 <br />