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SAN XACU(M CCUNTY N HEALTH S"cRVICES/E4VIRC4NEHTAL 4EALTH Oiv{...., I Atc I --�]? <br /> UGST .t. Ei FCR SITE CLOSURE EVALUAT(CN <br />�E OF FACT LIiT <br /> AHK ID Y <br /> DRESS <br /> HK SIZE �0��) UEL TYPE ( ,gjty j- <br /> 0<4ERAL SITE HISTCRY <br /> o ermit ! - acil icy Sta cos Code <br /> ,.Ta It/Gu Cone as <br /> o <br /> ;ermit current? ies <br />:»:er of Tanks at facility <br /> ge of Tanks(if available) ype of tank reel �Fbrgl ngl Oust. <br /> WK HISTCRT <br /> If yes, gidate(s) <br /> Tank ces:ed7 as 0 ailed precision test 7 as o ve <br /> a repair made Co the tank system? as 1.40 f yes, what was repaired7 <br /> repair dee order inspection? � es o ere soil samples analy:edi es 0 <br /> TXE H-GI IPH•0 b/E78 <br /> e of faiture/discharge atascraphie I ltortg-terts leakage verfill nown cher: <br /> '•:'OVAL 4ISTCRY CATTACi 11 SPEC, CN lEPCRT FCR SITE OETA(LS/COLLECT DATA FCR L"cAC,.IN POTENTIAL ANALYSIS) <br /> kcal Average Arnual Precipitation = �I4 0'25 <br /> i; Samples Received as a epth to Grctrd 'facer lar? of/Year �j,( J <br /> Site Well(s) Hes I o ;umber 3 Type Ilrr 'b g tor_ S care <br /> S care C pts <br /> ft; <br /> ft,- fc C 0 Pts C pts 'f <br /> tante to 'VeIL(s) from lank ) 0 it 0 if O <br /> R cndicion a odition R audition <br /> C is .net E is met E s met <br /> Site Feature - Leaching Potentlal Analysis <br /> I 1-100 Q 125-50\I <br /> imam oepch to groundwater from the Sail Sample (feet) >100 <br /> f I Hone I Unknown resent <br /> clunes in zubsurI ate (applies to foothills or motncain areas) O <br /> rage Arnual Precipitation (inches) <br /> xxxx I <10 I 9 1 0.25 26-GO\Z <br /> xxxx 1 <br /> -Made conduits -.hick increase vertical migration None I ( Unknown resent <br /> leschate (i.e., septic system, water watts, Cords) <br /> At leas: are than <br /> Cue site features: Recharge area, Coarse soil, nearby weds. one <br /> z/xxx Mme <br /> CCLL" TOTALS>>>TOTAL PONTS 6 ' <br /> RA4GE OF TOTAL PONTS 9 pes or more I GI • 48 Ccs 0 Pts or less <br /> le Resul:: (8 7 X CR E) <br /> R T � X E 3 T X e- <br /> P NA\3 <br /> MAXIMUM ALCGVA3lE 3•T•X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1 <br /> SOL VIE 1000 I 100 10 <br /> le Resul': DO i)'` e <br /> L 7i AXI MJN ALLCC:ABLE TPX LEVELS (PPM) IES'd 10,000 7000 100 <br /> 0� TPH— <br /> THOTES: •"tf docuIented soil and/or ground water cancam;nation is present, do not soft ace the hir. po tial <br /> analysis. (i.e., site is currently an LILT Coneamination Lis' for soil or atite.9rCIUnd wager. <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 Points. If depth <x5 ft., da not use cable. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXIE are not applicable at a TN concentration of 10 ppm (gasoline) or, 100 ,gym (diesel). <br /> S <br /> TAFF RECO WE40ATICH/CCNCLUS(01c / � ; \ <br /> Are dTX i : or TP9 Cancencratioro > Lovable Levels Tesl I I <br /> Rrmt <br /> oerd Site Closure as o if Yes, Refer to Sita Mitigation for Evaluation <br /> .RE111E'V :VALUATICN • TO 3E CCMPL:TED 3Y A SUPSAVISCR/SE41CR <br /> 4C'R 'VITA STAFF JECCNNE40ATICH FCR CLOSURE YESI 0 I �lEFERRED TO SITE HITIGATICH FOR :'ULLIAT ICH I I O <br /> E .TEFE3RE7 I / / yATE CLOSURE LETTER MAILED <br /> .c CF <br /> .tLUATCR <br /> 23 do (UGiZSHT)\5/50 . <br />