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SAN JCACL'I 4TY PUBLIC 3EAL7H SERVIGSlENVIRONMEYTAL e` 1-'i 0[VISICH <br /> I, �✓ 1ST 40RKSHE_T FCR SITE CLCSURS EVALUATION/ ICATE1 <br /> • <br /> NAME OF FACILITY ISZ:E=oS CCl)Ei / '� <br /> � Pla- L <br /> lADORESSi >�all, r � c�c_J� /0- yt.A K :II <br /> TANK SIZE! FUEL TYPS ! <br /> SIZE! 1 n oo I n Y`�-w� it Cc s v�re <br /> II. 1'E14E.RAL SITE HISTORY <br /> Is zermit current? Yes Nal iPermhit :' - iFaeiLity Stotts C;ce{ 1jOae.SoitlGi CxhtfYes� fNaf <br /> Nt.-:eer of Tanks at facility( jAge of TanzsCiT avai(aale)I (Type a-e Iank{Sceetl jFbrglj �Snglj 0ualf <br /> Iii. TANK HISTORY <br /> f <br /> jWas lank cesteo?IYesf Naf IFaiLeC Precision test ?iYesl INoXE4 yes, Sive ate(s) <br /> i <br /> , <br /> Was a re0air made to Che tank system? <br /> MCI :` yes, what gas re irea?( <br /> Was repair done under inspection? Yes} iNol were soil samples analyzealIYesl iNo► IBTXE; l !f-ii �TP!t 31 �Pb/E78f i <br /> Tyce of 4ailure/discnar3el �catastrepnicj tang-cern Leakagel javerTi(Lj �tahim.1 'anter- <br /> IV, 1EM0VAL HISTORY (ATTACH iNSPECTIOH RE.x]RT FOR SITE DETAILS/C=f' Cr. DATA FOR 'UACNIYG POTENTIAL ANALYSIS) <br /> SoiL Samples ReceivediYesi 19ol 10ept.'t to bound 'dateri iReT/Year( Average Annual Prxip1t3tiaa1iA=1i4 fi0-S <br /> �on-Site WeU(s)'Yesf �Naf INunoer �. Type( ilrr{ 10.1, 1P=1 <br /> S Scare ! S S=re i (Scare <br /> Distance Co uei l(s) from Tank C t0 pts C 9 vts C E5 Pts <br /> 0 if 0 iT 3 !tr <br /> R = aitian 2 cortdician 2 c..ndition <br /> V. Sire =eature - Learning Patera at Analysis _ is .met { _ l is met _ i is .'met <br /> Minimun Depth to grounmater `ram -e Soil Saacle C°e-_t)L/'L` ! I >I00 <br /> Fractures in suc5ur'aca (applies :o foot;hiits or .mountain 3ress) / �I vcne j :mnown ;Present <br /> (Average Annual Precipi taticn (inches) 9 ?0-25 la cxrocf Z5-:0\2 <br /> !Man--Made conauits which increase ver'icat nigraticn I I l f ! f <br /> of Leaciate (i.a., septic system, water .ells, Portes) t ( vane i unknown IPr�ent i <br /> iunique site features: Recharge area, coarse soil, nearly jet Ls. I At Least{ 'Mort' than <br /> i (>caoc:oc� .vane ane( i one <br /> i <br /> i <br /> ! CDLL?1N TOTALA»TOTAL POINTS ! � I � � j � � i- �t3 � <br /> iSamoLe Result: (9 T X CR _) RANGE OF TOTAL PCINTSfi49 Pts or ;more :; :3 r :d Pts or less <br /> r K I Ak} _)(0 Al '. N v <br /> r — - }� _ 3i - ` <br /> I I U 14AX1 1 ALLCSIABLE 3-T-X CLVV-S CPPIM)� 11 :Oi 501 5 ( .3 i.S i X. t. VA\3 <br /> Sa=te Result: IGASCLINE 1000 I 100 10 f <br /> MAI" ALMMLE TPH CES (PP ) <br /> TPH AAa <br /> 10IESEE_ m'= ! i000 SCO <br /> ';FCCTNOTES. —If dccmented sai l and/or V=end water contamination is not ==Late Lea=ing potential <br /> analysis- (i.a., site is curenrty on UGT Canramination lis or 3raatd cater.] <br /> i \1 If death is > 5 Pt. and < Z5 Pt_, score 0 points. If death =5 ,'t_, p not use cable_ <br /> \2 If precipitation is > 40 inches, sabre 0 points. <br /> i \.3 Levels Por 3TXEE are not applicable at a TPH =.,c-.cation of 10 ;;F= (5asotine) or t0O C;a (dieset)- <br /> I <br /> 'VI. STAFF RSC MME'l0ATION/=MCLUSICY <br /> 1. Are 3TX b ? or TPM Concentrations >`ALLLawadie Levels ('YesjxiNot <br /> Z. RecoCmhend Site CtosurajYesl INoi X L-If Yes, Refer :o Site Airigation for :valuaricn f fj(P✓.ayJld_/� <br /> I � \ ✓J <br /> VII. REVIEW _VALUATION - TO 3E CCMPC�iE3 3Y A SUP£4VI=/SE41CR <br /> j=14= '.4ITH STAFF RE-=C:MMEIOATTCN ?R (:�•.^4t. 1REjYES1 +HCI fRE3-=Rxm TII Sim yrTTCATZCM FCR E-VALUATiCNIYES! tNCi I <br /> IOAT <br /> E REFc2RED / / (DATE c:OSIIREL:C ic2 MAI1-0 <br /> NAME OF I <br /> !EVALUATOR) <br /> °H 23 30 (UGTWKSHT)\5/90 <br />