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SAH XACWH C.r'YTT 4EALTH SZ3VIC:5/E-WIRCHMEVAL :fERL,TM 9I11 <br /> UCS" ''% ' .T FCR SITE CLMIRE EVALUATIN N A[c <br /> :E CF FAC;L i TT I Ldp G��. / S � '•EE? w 4 <br /> asss I 03 } <br /> Lim- <br /> 9z SIZE QLIEL rTPE %Pr <br /> "c4EM SITE ' STORY <br /> rerai t eurrcneT �es o srmi C � - ae i t i cy Status Cade '� ac.Sa i t/G.7 Carst es a r <br /> riser of Tanks at favi t i ty �Se of ranks(i f avai table) ype of .fardc ceeE �Fbrgl mgt 0T <br /> WX 4ISTCRY <br /> it <br /> bank Cested7 des a ailed preeisian test 7 �'es a If yes, give ,date(s),i / ! <br /> k <br /> s repair mode to the tank system/ es Va Eyes, what was repaired? ,i F <br /> repair done seder insaeetianl yes o Mere snit samples anaLy%ed7 i as a�� TXE PN-GI PN-0 b/E06 <br /> e of failure/dfseharge i,aeas:raphic lartg-comm leakage erfitl n cher: <br /> i <br /> !.wOVAL MSTCAY (ATTAC3 (NSPECTICH iE2CRT FOR SITE DETAILS/COLLECT DATA FCR LcACiIRG VTEYTI.r1L ANALTSIS) <br /> L Samples Received I es a epth to Ground 'lacer of/Year Average Amuat Preaipitatian = II4 0-25 <br /> 1 : <br /> Site JeMs) �'es n amber i Type Ilrr <br /> S care S '' car- S care F <br /> tante to Vetl(s) from Tank ft; ft,- ft C 10 PCs C k pts C pts <br /> 0 <br /> it 0 if 0 f <br /> R ondicicn R mditinrs xar+diC!an <br /> Sice F-eature - Leaching Pocenciat Analysis "c is met E is met E s stet <br /> imam Oepch to grocr-d+ater from the gait Sample ifeet) I >ICO 1-ICO 25-50\t <br /> ctur:s in subsurface (applies to foothitts or =Lncain areas) !(one Fi Unknaws �resenC <br /> rage Arnuat Precipitation Cinches) <10 9 10-25 I Z6-GO\2 <br /> -4ade cnrdA is which increase vertfcat migration <br /> leechate (i.e.. septic systems, water welts, ponds) Vane 7� ;iI Unknou resrnt <br /> qwe site feacUres: Recharge area, coarse snit, nearby wells. Pane ,-�J k At leas. lere than <br /> `fir one <br /> CCLLM TOTALS >>TOTAL POIMTS • �� + <br /> Le Resu(t: (S T X CR E) 2ANCE OF TOTAL POINTS 9 pcs or more 4111. 48 pts } 40 PCs or less <br /> /Y <br /> w► / MAXr.". ALLCWASLB 3-F-X-E LEVELS (PPM) I 5O 5O 50 <br /> Ee zesvEC: /7i{ �ASCLIVE =0 � 5;00 fO <br /> �1" ALLCI»ASLE TP4 LEVELS (PPM) <br /> / TPH IES'cL 10,000 I 1000 100 <br /> IvoTES: "'If doeumenced soil and/or grord water contamination is present, do aec camplece the teaching pat sal <br /> l aratysis. (i.e., site Is currentty on UCT Concamimcfan List for soft or graced water.) <br /> 3 �d %I If depLh is > 5 (t. and -c 25 ft., scare 0 points. If depth —i ft., do not use table. <br /> \2 if precipitation is > 40 inches, scare 0 points. 1� : <br /> 13 Levels for 3=;E are mac applicable at a TP4 concentration of 10 ppa,�(gjasoIne) or 100 Ppm Cdieset). <br /> F <br /> rAFF XEMWEMOATMR/CCIIC'_USCCU , <br /> Ara 3TX L "e or TP4 Carx.ntrations > Attowabie Levets Yrs a I� <br /> Recammerd Site Ctosure res �l0 1 If Yes, Refer to Sic* Mitigation for _vaEuation <br /> E`fIZU =VALLIATIClI - TO 3E CCIYPI=TE? 3T A M7VtVI=/S'e4ICR <br /> a;R IT3 STAFF RECC.A.fSVOATICM FCR CWSURS �fE3I �0I �E?"e3REO TO SITE MIrIGATICNl�;FOR EVaLUATI01 <br /> ATS =13SURE LETTU MA1450 <br /> CF <br /> LUACCR C�6G5 ,j <br /> z3 au (uc;xsar)�5/sO <br /> . it � <br />