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SAN :OAIXMIN CCUNTT#%IC HEALTH SERVICES/E.WIRCHMENTAL HEALTH 0 0.ON ! <br /> UGST :, +SHEET FOR SITE CLOSLRE EVALUATICH Lj AIE <br /> FAC, <br /> ( CLITY I ` ) �O . VEEPS.CCOE <br /> nORESS ANK ID 'O Z/ <br />')nNX SIZE 1p ODO L TYPE CC.4--, <br />. GEHE.RAL SITE HISTORY - <br /> 1s permit current7 es4a ermit Y DV' anility Status Code O ( Say/Gu Cont es o <br /> ranter of Tanks at facility ge of Tanks(If available) 14 r5 ype of Tank teal brgl ngl Dual Li <br /> I. tANK HISTORY <br /> Jas Tank vested? i as 10. <br /> ailed precision test es o V11 yes, give date(s) <br /> las a repair made to the tank system? es No I VIIf yes, what was repaired? <br />:as repair done under inspection7 esI PN 06 dere soil samples analyzed? 11 <br /> as I o I TXE I PH-G I P11-0 b/E08 <br /> type of failure/discharge I atastrophie long-term leakage verfitl n 1 10cher: <br /> REMOVAL HISTORY (ATTACH 14SPECUCH REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br />:oil Samples Received es I o epth to Grand 'lacer of/Tear verage Annual Precipitation k. t. 0-25 <br /> 1n-Site Wet L(s) es o umber L Type I Irr I ub <br /> ly S Score S Score S core . <br /> iistance to Wetl(s) from Tank ft; f r, ft C 10 pts C P pts C pts <br /> 0 if O it 0 t <br /> R onditicn R condition R ordition <br />�. Site Feature - Leaching Potential Analysis E is met E is met E s met <br /> iinimum Oepch to groundwater from the Soil Sample (feet >100 1-100 25.50\1 <br />'ractures in subsurface (applies to foothills or mountain areas) None I Unknown oresent <br /> verage Annual Precipitation (Inches) xxxx <t0 9 10-25 Kxxx=x 26-40\2 <br /> ion-Rade Conduits which increase vertical migration <br />�f leachate (i.e., septic systems, vater wells, ponds) None I Unknown resent <br /> nia:e site features: Recharge area, coarse soil, nearby wells. At least 4cre than <br /> xxxx NWt one we <br /> COLUMN TOTALS»>TOTAL POINTS <br /> amnte Result: (8 T X OR E) RANGE Of TOTAL POINTS 9 pts or more 41 4a pts 40 pts or less <br /> a TX E 3 T X E <br /> MAXIMIM ALLOUASLE 3-T-X-E LEVELS (PPM) 1 111 50 50 50 .3 .3 1. 1 1. 4A\3 <br /> ample Result: OLINE 1000 100 10 <br /> IMSRi ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESEL 10,000 1000 100 <br /> CWHOTES: ...if documented sail and/or ground water Contamination is present, do not canplete the leaching potential <br /> analysis. ((.e., site is currently on UGT Contamination 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 > 40 inches, score 0 points. <br /> \3 Levels for 3TXEE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECCWEWATtCN/CCNCLUSION p <br /> 1. Are 3TX 6. E or TPH Concentrations > Allovable LevelsYes o t <br /> t. Recommend Site Closure as o If Yes, Refer to Site Mitigation for Evaluation <br /> REVIEW EVALUATION - TO 8E COMPLETED 3Y A SL'PERV150R/SEHICR <br />:ONCJR WITH STAFF RECCMMENDATION FOR CLOSURE E-a 0 EFEAREO TO SITE .4ITIWTICN FOR EVALUATION �ES 0 <br /> WE REFERRED ATE CLOSURE LETTER )AILED t f -% <br /> unrE OF <br />:VALUATOR <br />:H 23 80 (UGTWKS T)\S/9 <br />