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SAN JCACUIN CCUNTI IC HEALTH Sc"2V10ES/ENV[RCN4ENTAL HEALTH 0 CH <br />(, UGST (SHEET FCR SITE CLOSURE EVALUATIC'N AIE <br /> Un"E OF FACILITY I UI I I a� �J I ' l� - Mal�jVj 0\ SEEPS CCOE logg <br /> RE SS C1Y� LJWL� Tl !� /� ANK !D X (D-3 <br /> r ^ ^ n <br /> '1ANK SIZE 1 OD UEL TYPE _o L,4 <br /> I. GENERAL SITE HISTCRY <br /> Is permit current7 des o ermit - O q V acility Status Code D, oe.So (/GW Ccntl es o <br /> Nuncer of Tanks at facility ) �1ge of Tanks(if available) 0 r5 ype of Tank tee) Fhrgl rql Oual <br /> If. TANK HISTCRY <br /> i;ns Tank tested7 es o ailed precision tes 1 es o If yes, give date(s) <br /> !as a repair made to the Lark system? es No IV f yes, what was repaired? <br /> as repair done under inspection? Hes ere soil samples analyzed? es 0 TT)( PH-GI IPH-0 b/EDB <br /> ype of failure/discharge atastrophic Ilorg-term leakage verfi[( nknown cher: <br />/. REMOVAL 41STCRY (ATTACH INSPECTICN REPORT FCR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Fail Samples Received es of epth to Greu�d 'dater of/Year verage Annual Precipitation = f14 0-25 <br /> -Site 'de[L(s) es o umber 3 Type Irr an ub <br /> S core Score S Scare <br /> istance to Vell(s) from Tank ft; ft; ft C 0 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R cndition R ccrdition R cndition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Minium Depth to groundwater frcvn the Sail Saaple (feet) I >100 1-100 25-50\1 <br /> ractures in subsurface (applies to foothills or me stain areas) None 1 Unknown resent <br /> verage Annual Precipitation (inches) xxxxxx <10 9 ( 10-25 xxxxxx 126-40\2 <br /> 1 in-Made corduits which increase vertical migration <br /> bf leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> __T_ l <br /> :;niGue site features: Recharge area, coarse soil, nearby wells. At least ) are than <br /> xxxx None one I one <br /> i <br /> CCLUHN TOTALS>>>TOTAL POINTS * I + <br /> amale Result: (3 T X CR E) RANGE OF TOTAL POINTS F9 pts or more 41 - 48 pcs 40 pts or less <br /> fT[5T X ° B T X E <br /> 4AXIHLH ALLCtlASLE 3-T-X-E LEVELS (PPM) 0 I50 ( 50 I .3 .3 1. 1. NA\3 <br /> 100 10 <br /> ample Result: GASOLINE 1000 I <br /> AXIMU'M ALLOWABLE TPH LEVELS (PPM) <br /> TPH DIESEL 10,000 I 1000 I 100 <br /> COTNOTES: -If docunented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (i.e., site is currently on UGT Contamination List for soil or grour+d 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 > 40 inches, score 0 points. <br /> \3 Levels for 3TX3E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECC7+ENOATICN/C0N[LUSION <br /> , 1. Are 3TX b. E or TPH Concentrations > Alto wa a Levels Yes o <br /> � 2. Recommend Site Closure Hes o If Yes, Refer to Site Mitigation for Evaluation <br /> . RE'/!EJ EVALUATICN - TO 3E CCHPLETED BY A SLIP ERV I SCR/SVI I CR <br /> CONCUR VITH STAFF RECCNHENCAT[CN FCR CLOSURE IB ES �!0 I EFE.RREO TO SITE .MITICAT[CN FCR EVALUATICH (HES T �O 1 <br /> )ATE REFERRED / / q PATE CLOISJRE LETTER MAILED <br /> iArE Cf <br /> "`/,tLUATCR <br /> EH 23 30 (UGT'dKSHT)\5/90 <br />