Laserfiche WebLink
;I SAN :CAQUIX r�?{)3LIC HEALTH SERVICES/ENVIRM ENTAL HEALT' 'VISION <br /> I. "XSHEET FCR SI' CLOSURE EVAL'_AT11CM \___�� (DATE, <br /> ` <br /> ISUEc..-S COLEMAl. ! + <br /> _ g <br /> Y IAIDC RE-SSI 3 Jv S �' TANK ID *I <br /> ITAxK SI-""� FUEL -,r,-- <br /> I <br /> Y?EI I. :ENE;.AI. ITE H I STORY <br /> +Is xrrit :Axrent?IYesl IMoi Permit t) - Facility Stars Code)j 2- !Doc ail cmtlYes o� <br /> }reser of Tanks at facility lAge of Tanks(if available) (Type of Tank ISteel l v tl ISrgtI Duals <br /> III. TANK HISTORY <br /> �l a; Tat* ` -sted?IYesI IMo) Faded precision test ?lYes INo If yes, give date(s)I <br /> No!Was a Ms":Tr made to the tarsi: systewlyesl rod IIf yes, "mat was repaired? <br /> Ls ret:V ane Trader irspec:ian?IYes IMoi 'were soil sa=les analyzed?lYesl INoI BTXEI ITPH-GI (TP4-01 IPh/--8! I <br /> IType o ::Ai Lure/discharsel (catastrophicl Ilona-term Leak wi overfill) Iur&. lother: <br /> .Y. 2E!1(.M 3ISTCRY (ATTAC3 INSPc-=ICM REPORT FOR SITE DETAILS,=LLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ISoi[ Som s ReceivediYesl lrol IDepCt to Srard vaterl IRef/Yearll Qj-f�; (Average Atsual PrecipiLatienIA=I14 I10-25I <br /> i <br /> O Site ' rsi(s)ITuesl I >/ rr <br /> Mol,/lb Typata <br /> es IIrr IDi (Ptd <br /> s Score S Score i s j sere <br /> D� isLare^ `.o Je{t(s) from Tank ft; —ft; _ft C 10 pts C 9 pts C 5 p <br /> las=, I 0 if I 0 i f 0 IPr-3i f <br /> R condition R conditionR condition j <br /> ?i Y. Sita t'eature -Leaching Potential Anatysis E his met I = is met i _ +is met <br /> IMini;�. 7a to groundwater from the Soil Sade (feet) �_ �� I >100 I 151-100 25-5J\1 I <br /> IFrr rum in sucsurface (applies to footiills or mountain ar:ss) None I q i LX-,ictosat I j?resent <br /> i I Average Aiix z l Precipitation (i aches) X0000r l <10 ( 9 I 10-25 j mauca z 125-4J\2 <br /> LM rt-MMc xduiis which inc.--ease Yerticat =isration q <br /> Iof lei:. (i.e., septic systms, water welts, ponds) j None ! I Uric. t `Present j <br /> univa si a features: Rea—hare area, coarse ;oil, near+y alts. j I At leasLl <br /> ax+ sora <br /> (More :! <br /> xx�000: rax q one <br /> COLLM TOTALS»>TCTAL POINTS <br /> Sacsial,, ZmLt: (3 T X M E) RANGE OF 7MAL POINTS 49 pts or more i 4.1 - 4a pts �/40 pts or less <br /> �' MAXIMI?( ALLO6A3LE 3-T•X-e �=VELS (PPM) 3I SOI 50� 50 I ..3 I.T <br /> 3 1.I 1 I <br /> u�3 I Il <br /> ISMAe, stsi t: i (GASOLINE 1000 i 100 ; I 10 <br /> MAXIMLAL ALLOW3L"c T?' LEVELS CPP") <br /> "�v; Tps C,—, I D I ESEL 10,300 I 1000 100 <br /> !FOQiMITii:S: *"If documented soil arsdlor ground water =ntamination is ?resent, do not complete the l a[ <br /> ; aratysis. Ci.e., site is currently on UGT Contamiration List for soil or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth —5 ft., do not use table_ <br /> %2 If precipitation is > W inches, score D points. <br /> �,3 Levels for 3TXSE are not applicable at a 174 concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAri 2E- AT IC'M/COMC.:SIOM <br /> i. Are 3TX b E or 'PH Concentrations > Allowable Levels 'Yes VINOI <br /> 12. d Site CtosurelYesl MoI �If Yes, Refer to Site Mitigation for Evaluationi <br /> V[I.. ZM-?:.'11 EVALUATICM - TO 3E =WL_STE'1�. 3Y A 9-PE VISOR/SMX <br /> CML_: .:-H STAFF REC344E?i AT I ON FOR CLtSM(TES L,,tNC j I RE FERRED TO SITE MITI GAT I OM FOR EVALUAT I OM J YRS}-' I NGI I <br /> DATA REicR10I / / = iDATE COSI L_=TTE,2 FLAILED+ <br /> NAME OF <br /> " TORI ^ <br /> EK 23 30 (UGTUKS4T)\5/9O <br />