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LFI## ' <br /> SAN 1LJAQlIbN CW* #.1C HEALTH SERVICES/ DATE <br /> ` DATE Y - <br /> HEeT FOR SITE CLOSURE EVALUATION }"'^ <br />` ucs _ , <br /> t gjEE?s comE ; <br /> NAME Of tACILITY 'G�{7 iTAPK To *oq <br /> ADDRESS <br /> r - r fL TYPE1 Vi=e. 1 <br /> TANK <br /> tt. :OENERAL SITc HISTORY staCus Code 1Ooc.SoiL/GW CantjYes r <br /> Permit � �Fact ts'Cy • <br /> iserrtii t current? Yes4 Na - <br /> s { 5uat� <br /> Age of arikst i s avai takfi e J Type of T ank l sleet Fbrgk <br /> Nszt+ber or' Tanks at facility , <br /> [it:; TANK HISTORY / <br /> Was Tank jested?: Yes go� �Faited precision rest ? YeSj �No <br /> if yes, give cartes) 1 t I <br /> sYsteas? Yesi[ Nal IIf yes, shat w s repairedI <br /> �41as a repair made•to the tank , <br /> Nab BTXEitPN-(;f N-D TPiPtrJE08 i <br /> jpns YeSf No were sail sampkes arta{yzecriyes# <br /> Was :eoa i r clone:under inspect I `' ' '.otI <br /> Type �f -aiLureJrlischarge cstastropiei€ hong-cerm Leakage �overziLtj junknowni <br /> IV. REMOVAL HtsTCIRY tATTAGH IN5?E+`:[ION �2E?ORT FOR SITE JETAILSJCOLLECT-DATA MR �-fiAGJIIHta �QT'��iTTAC ANALYSIS) , ; <br /> i � .Iater� }ReflYear Average fanrt+aak ?recipitaciei=itb # -ZS <br /> Sort Samctes Receiveil�-Yes V t <br /> Depth ca Grcwnd ' f <br /> j j , <br /> No 40 <br /> W"ber 3 Type Err �apmt SPub S scare S sScore ; Scora <br /> lOn-Site wetL(sdyesi q ptg.. C �S pts <br /> {t� �ft; rt C t4'�cs if <br /> Distance co "tett(sJ Tram Sank -- 0 t. 0 it <br /> R ecttxlizian condition g condition. <br /> is WIC ft <br /> stet is <br /> -met <br /> Leaching ?otentiat Anatysis _ <br /> ` <br /> lMtni xess Oeoth tc groundwater from ate soik saw: <br /> le fPresenz <br /> frac.arss #o <br /> to subsurface (a¢plies :a othttts or mountain areas) } #tole <br /> 9 <br /> Average 4rtnuaE Pr`ecio talion times) <br /> �xxxxxxi ai0 �. <br /> conduits which increase erticaL migration None Unkno+I 1016esent <br /> Man-made -ter Melts, Pte) � I � r <br /> of '•tacttate t .e., se rtic systems, Fftre dtan <br /> R {..At tees>r Illi <br /> .parse wait, nearsY wattB: None } <br /> �Uni;ue site 'eaturesz Rectar+3e area, ! one ' <br /> fes: <br /> COLAMM <br /> TOTALS>S>TOTALi: NTS. <br /> 1.#: '.$ <br /> r.0 ar fess <br /> OR E�: :QhfiGE dFTOTAL..?CIdtTS 4q pts or mare <br /> ;t Sawie RTULt- IS t Xpm. ; <br /> !: <br /> VD <br /> 9 T It <br /> l r x <br /> t <br /> TMlM atlt3WAR4 :3-T-X- t.EslEJ:S tPlYM) 1 50 Sol 50 <br /> r GASOLINE 1000 .. � Ica 30 <br /> Samoke::Resut t^ . .. ..... <br /> 6'{+� iyt ( flt iy *AXIt+IIIFF ;�t,1:OkiA LE FPN tt:VEL s:tPPM) OIESEL 10,400 1040 #00 <br /> tI <br /> t TPN certti'al. <br /> +e++.. est soil aurdlea" ground suer contamination is present, da ,not compket<e the Leac#ing <br /> FOOTNOTES: Lf.dao►�nt site is currently on UGT Contamination List `or sail or ground floater,) <br /> atta{ysi3. f=.e-. 1- f�'.,.do trot use table <br /> tt 11: If depths � 5.ft. -and < ?. ct., <br /> score 4 paints. if depth <br /> If precipitation is > inches, scare fl paints. :or #OO..;ppaf tdieset3.. <br /> lir.abte ata TPtt concentration of CO ppa (SWI•Levels War 87X ,arts::raft app . <br /> Vt. STAFF Rt:CC71 eX0At1ON/CONCLtMIGN. <br /> 1. Are 3TX '8. = .or TPN Coneentrat�isms > Allowable !eveis=*"YeSl�=: <br /> HoTes.. No . tf Yes, Refer so Micigatiarf far Evatuae of <br /> VII. REVIEW EVALUATION:- Tri:3E CC,41Pt zTED 3C A SUPERVISOR( tOR <br /> i NO jREFRRRED TO SITE M1TtaAT:iON FOR EVALUATIow I'cs : NQ <br /> YES <br /> CC4 '�IiTH ;STAPi RErOpDiE RT1ON FOR CLQ 1 <br /> {, DATE ,REFERRED J . .f <br /> _. `OJ1T1: CL05(►RE L.ETT ER +tAILED f �" <br /> ' ... <br /> t NAMte:OF <br /> IEVALUATCR 1 <br /> EN:'2 30 CuGTUK!AT1\$/." <br />