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SA]! JCACLiIJI CR ?USRIC " AL-IR SUVICZZ-A tVIRMNEsITAL i <br /> 4s, ==HEwT FCR SIT: CL=122 r.sta:t <br /> ^ IALU/ITtCN DATE <br /> !+IAME CCI <br /> F FACILITY <br /> f .� S 7 rUc / �— <br /> {LI�/ s-/ SWEEPS =F- <br /> ADO It!33 5 Lo Q mj <br /> 'TAR✓ SIZE FUEL TyPQ • S� T,y}IfC f0 � <br /> II. Gc:rE2AL SITc :iiSTCRX -F/l!1 <br /> �ts permit currsncllyes Imo psrait x� <br /> IFaciEity STU= Codef� Iaoc.Sait/mi cznclyes� <br /> 1 <br /> Naber of Tames t No <br /> ac faeiti <br /> 'y -3 �Aqe of Tanks(if avaiEaole)I <br /> Type of Tank�Ste*l Fbrgl Sngl OuaLr <br /> t'.I. 'ANX .f I STLIRy <br /> Rias Tank :ested?Iyes� JXQJ Failed pracisian ;est 7�yes' IMaf 111, yes, live data(s)� / <br /> Itray ropeir mode :a he :a* Systm? yes No �If i <br /> Yes, 'asst vex repaired? r' <br /> O a2� <br /> ileal repair done wider irsaQec.fan? les f No �Yere sail ` V <br /> saatslas analyzes?j yesjNo STXE ,TP!1-GI ITPH—ta Pb/E]8� <br /> Type of faiturrJdischargal' �caeaxerophic� f lana-cera Eeafcage� aver#i[lf Iussia�oin� ath <br /> ;3ISTC$7 (A77AC8 IYSP£CT � <br /> 'tel IEPGXT FCR SITE OETAiLS/C'LLEC7 OJLTA FCX L:J,C'dINt; ?CTE7XTiAL AiIALTSIS) <br /> (Sail Samples geceivedlyll No# 11�DeptA to Grots>d ;talar 1-11-1111117 : <br /> } i 4�DIRefraorrAv.rage An <br /> PracipitAtfan A��14 ItD-?5 <br /> IOn-Stce VOLL(s)IYes� +Not Ixubber 4 Typrl Ilrr IQm1J { <br /> jaistanea to WetL(s) from Tankft; �.. f { S Score S Scar_ S Score <br /> _ . ,.�. •, `ft C ?a PCs C 9fpts C S is <br /> a if <br /> !. •cite =eatura - Laaelsi Pcteneia[ AnalYs i s R condition R cenCttian R et <br /> i s ae e <br /> is eat is sec <br /> ?1iniQrm Oepch co ;rac'dsracer frac :.'Se Sail S to <br /> � (feet) >SQO 151-1C0 I -5-4a\t <br /> � <br /> roe; tees in s++burrfaea Cappl fes: cd fooctti E Is or tain areas) <br /> Nom Unl±tsowrs I Present <br /> Average Arrxrat PrecipitAtion (irscses) <br /> '10 9 Ta-d5 l el Z5-4a�2 <br /> ]fan-lade aar>Cuits 'al ien ice.-ems+ ver;ipl sigratien ! <br /> 'ar :aaehaca Ci.e„ septic systema, Water wells, ponds) I <br /> Naar ' I lPresenc <br /> :Unigya lice femur-sa Recharge area, coarse sail, neer✓. vel Ex. <br /> j I Q At Leaf Mara ;loan <br /> x>raoea ?lore! I! Tr Jl `aw <br /> Cv1.19M11 Tt3TAX,�»i�.LL ?17I11T5 I W 7 1 ` � r V J-- 3 <br /> iSawLe 3esut:: Cs T X CR • <br /> =)a AAitaz aF TOTAL.PRi)i7S G4 pas or cors J SS :3 pea I SLI is or Eels <br /> ;<Jl�.r.e, - �. In�q/K <br /> !IA)t2}!aX ILLCLtABLx 3-T-x-E LEVELS CPP41) t Q Ste �D <br /> -7� <br /> saaa a 3esulc: =c� - <br /> 5. Ar>xSL:CiNE low <br /> pH— Ty <br /> JXAXI" LL�C6ixgX_ <br /> Tp, L"YEiS (PP!!) DIESEL - <br /> X 1a,flC0 tam f Ini7 <br /> !1e16 .WESs '"'Tf dorazlmerd soil and/or lr=rsd velar :crscaminetion is <br /> f mrtalysis_ (I.a., site is present• eat complete 2tr Leaching potential <br /> \I t! darn > <. is 5 ft. and a s- �r-ti't,y °r' UGT Canxamination List for soil or grand Water.) <br /> 11 If pr!eipicacian is s �, =MrW d Points. If depth a3 ft_, do not =a table. <br /> 4 inehrs, se=ra a points_ <br /> \3 Lawls for 3TC ars nag &apticabtr ac a TPH :ar�eancratian at Ta <br /> PPM (gasciina) or TDO ?pm Cdies:l). .1 <br /> Ill. TTAFF gECCWeMATICM,/=mC,_=tC7X ^ <br /> T. Are 3TX 4 _ ar -'pH C-'xfcrssrratians a AilowQle Levels }'yes �}lo} <br /> i <br /> Z. ;tocmmw1dSita C:aau�{ley No� L"If Yrs. Ra#:r :o Sita slltiggtiai for cvs[uation� .�+ <br /> lIL. 2�lIES♦ F! L1 O, <br /> LLWTIC71 - TD 38 CCIPt_r'T7 3= A We-WTD! c.ICR <br /> C_VL".,R VITH STAFF .ZE=4gFWATICX FCA ^ <br /> -�==f MjC,1jNCj StEr` RE] i� 'aI�< 71ITICA7ICi ' yS <br /> � 1 FCR rIJIL.LtTTC,]i1,�3{ UNCI <br /> .CATE .ZE?=3RIM fd / �C1 / of �! �CATE rte. iE Ali JVIIIJ� <br /> i r 1 ! / <br /> lHAtlE Cf � <br /> �E <br /> VAWATU <br /> -H :3 3a <br />