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■ <br /> SAN JCAC,JIN C iC HEALTH SERYIC:S/EAVIRCNMENTAL HEALTH i:N <br /> I Uc; <br /> ;NET-T FCR SITE CLOSURE EVALUATION OATEI <br /> NAME OF FACILITY I ISWEEPS C EI <br /> ADORESSI (TANK 10 fI <br /> TANK S t ZE I I FUEL rYP£ <br /> It. GEVERAL SITE :iISTCRY <br /> Its permit current?iYes INo Permit t - Facility Status Coder Ooc.Soit/Cd Cont YesNGI <br /> Hunter of Tanks at ,facility+ Age of Tanks(if available) Type of TanklSteel Fbrgl ISngII Dual <br /> III. TANK HISTCRY <br /> Was Tank testes?IYes I INo Failed precision test 1 Yesl No Iif yes, give date(s)r <br /> 'Was a repair made :o the tank system? Yes Ho (If yes, what was repaired? <br /> :Was repair done under inspection? Yes rNol Iyer* soil samples analyzed? Yes INo, STXEI -TPH-GI (TPH-0I Pb/EDB <br /> iType of failure/disr-large catastrophic -long-term leakage) overfill) unkrwwnl other: <br /> :'I. REMOVAL 41STCRY (ATTACH INSP£CTtCY REPCRT FOR SITE DETAILS/COLLECT DATA FCR LEAC31MG POTENTIAL ANALYSIS) <br /> f :nil Samples Recaived Yes No Depth to Ground Water) Ref/Year (Average Annual Precipitation AZ 14 I10-ZS <br /> i <br />-+ C.n-Sita Vett(s)IYes I INoI INunber L Type) Irr1 Dam IPubI <br /> '-- S Score S Scare S Score <br /> :is-ante :o Well(s) from Tank) ft; _f t; ft C ',0 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> Site Feature - Leaching Potencial Analysis E is met c is met c is met <br /> m Depth :o grovrdwater from :he Soil Sample (feet) I >100 I51-100 i I 5-50\1 <br /> _s in subsurface (applies to foothills or nouncain areas) I I None I I Unknown I Present <br /> rage Annual Precipitation (inches) zx:ocxxl -10 9 110-zs Ixxxtxxc Z5-40\Z <br /> -Made corc�jits which increase vertical aigration <br /> r ;sachste (I.e., septic systema, water walls, ponds) I Hone I Uni� I (Present <br /> 1.,-,i5ue site features: Recharge area, coarse sail, nearby calls. IAt least More than <br /> =0=i Haw am <br /> CCLL2(X TOTALS »TOTAL POINTS <br /> ISaaala .lesult: (3 T X CA E) RANG'c Of TOTAL ?DINTS 49 PCs or more I 41 - 48 pts I 40 pts or Less <br /> 31T X - I '3 I.TXI C. IMAXIMIDt ALLOYAME 3-r-X-E "EVELS (PPM) t 0 50I50 , 1- YA\3 <br /> ISamsrte lesuit: GASOLINE t000 I IGO I l0 <br /> MAXIXX ALLOWSL_ TPH LEVELS (PPM) <br /> TPH OtESEL 10,000 I iCQO I ICO <br /> FCOT;;OTPS: *`*If documented sail and/or ground water contmination is present, do not coop/eta the Leaching potential <br /> analysis. (i_a., site is currently on UGT Contamination List for sail or grovel water.) <br /> \1 If dept.'s is > 5 ft. ard < 25 ft., score 0 points. If depth ­i ft., do not use table. <br /> \2 if precipitation is > 40 inches, scars 0 points. <br /> \3 Levets for 3TXSE are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 pCm (diesel). <br /> 1'. STAFF .RECCMEIDATICN/MICUSICH <br /> :re 37X L or TPH Cancentratians > Altowable Levels I'Yesl INoI <br /> Z_ Zeconmend Sita CtosurslYesl INoj If Yes, Refer to Site Mitigation for Evaluaticni <br /> I". .IFITEN =/ALUATTCX - TO 3E COWLETED 3T A SUPSAVISCR/SE.VICit <br /> =N=2 'JITH STA;F :ZECO)fE.XDAT1,CX FCR :CSUREiYES# iNO) IREFERM TO Si Tc MITTGATICN ;Cit 2/ALUATTCHITESi INO� <br /> IOAT'c (E.:RREDI / / (DATE ^-..OSURE �TiEA MAI LM <br /> AAHE 2F <br /> VALUATC2 <br /> 3 3 30 <:�asaT)�Si90 <br /> f <br />