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SAN J=Ut -41TY AMUC 4EALiH Sc3VIG5/eMRONME.'iTAL s: HE�J(VtS:CX <br /> : OATEI Z / <br /> rtKsaE=T cR « C..QSJRE ��ALuaitcK <br /> 1iAME Of FAC'Ml / <br /> w'NK iB -13 <br /> �ACaRE55� t <br /> !TANK SILeI PJEL SEI <br /> [I. Ce`aEi2AL S I i e 4I STCRY <br /> its .ermi t current?I Yes 4 No�x�Psi it :� - i Faei t i y Status Ga-dei I Oae-Sai that C=j Yes} I No <br /> yasnoer of Tanks at :aeitityl Z, <br /> AgeIfr,r* (if avaitab/e)� 4YtjType iank!Steell ./I'Ft;r3l� ISngl! OL. { <br /> TANK 41STCRT <br /> Jas lank tested?IYesI ISI Failed precision :es: ?iyesy INoI I(f yes. -live dace(s)I <br /> :':as a repair made :o --le Mr* systeatfliYesl 401 w1r,f yes, ,hat was -maired/� 1 <br /> :':as -epair done under irtsaee;ias?ITesI INa► �e!e- sail samotes analyzed/�Yes� 'No) BT � ?N-fiI `TPN lI IPtr/pHI <br /> "yce or failure/disctamel Icrtastraoeicl �lcng-tenu Leakagel iaver.'ilLl I• Iac�er: { <br /> iV. 1EMOVAL 41STORY (ATiAM (NSPE"TQN TSMT XX Siic zE'AILS/C=.'�'+T OATA RR �:a1CdFNG MM-MAL ANALYSIS) <br /> s Soi L Samples .Teceivedlyesl INoI IDeptts = Ccm= Waterl �Tef/Yearl (Average ArruaC ?reeipitatianlA=I t4 I10-sI <br /> (Cn-3itr WeLL(s)IYes I INaI Imtxcm & iypel (rr1 IOcm} lPva{ ` <br /> S `Scare S Scare S Spr± <br /> lO+stance :o JellCs) from rank ft; C 9 Sts C 5 pts <br /> 0 `hr O it O if <br /> 2 `L it'an i C= iVan x caditian <br /> iv. Site Feature - Leaching actentiaL AnsLysis a is met _ is .flet E is not <br /> iminimhm Oem= :o 9rma'="ter :raa rte Soil -aaaole C`eet) '��" <br /> IF^zc-res in sucsur-race (arpties :a fmtmitls or .nchattain ar--sl I r�j kre ! ' 'Jrshctatiet (Present <br /> i <br /> �:Average Arvtual ?rtcipitat•'an (Traces) I:00000c� <i0 I 9 tII- Iii -•:a\Z <br /> :mart-'-lade =ncuits which inc.-emse ver.=L aigratian <br /> :r LeaCtate (i._., seatic SYSTMas, water vet Ls, panes) ` l { Maze i tII7faxvn iPresmm <br /> !unique site -estur-s: Rell-M area, arse sail, mear^y •xt ls- At Leas:} ere clx,==l <br /> vane ane one <br /> aV i <br /> lel 4deP 9 �3s + rarAL57»rorAt ?DINTS (3 a - 4 I E I' <br /> l� Sample ResuL:: CS i X CR S) TAN.t--c JF TOTAL MINTS11-9.ats or oar_ ' 44 Pcs *r Les I <br /> Nb <br /> r x _ 3 r x I <br /> nMM MXr" ALLCWML` 3-r-x Li 'll �� :JI :a I ! i I1. i. I NA\3 <br /> sa=te Resin t: r��° LAG.1SCUIIE tarno I taQ I iQ <br /> MAXOM sTPx S CPQ[,) <br /> I TPNEs �D:E'S�r SII,tfOQ i iQOQ I too i <br /> P-rTNOTES: —!f do mmnted scit xW*r -lraund rater =nramnetian is Mesam, eraesin4 potential <br /> analysis- (i.e., site is csrrsncty an =T Cancmainacfon List far-sail ac- ground-anter.) <br /> i \1 (f depth is > 5 ft. and < 25 ft., scare CI points. If de= a5 `t da not use able- <br /> \Z If precipitation is >40 inCtes, seer+ 0 pcincs- <br /> ` V Levets for Sr= are not apptfcacte at a ?PN =m=rrcratian of 1II apo <5asoLine) ar 100 Ma (diesel). <br /> V1. STAFF 3Eta-7.MMENDATICHM O M 5101 (K (A) `j" = 3 D�a � <br /> AF- <br /> t. Are 3TX 4 E ar TPH C.xh wr=mtians > AL Lmambie LaveLs i*Test I Na IT t 8r,� �1'-b �7/i li <br /> Z. Recaamend Site C:oscelYes} INoI)<L-If Yes, Teter cm Site Mitigation for i mLuac:ct Q � <br /> L( ir,G �S�tv'�y <br /> VII. it:'/IEL �/ALUATICH - rG 3E CWt-c-IED 3T A 9AK-VISLNt/SEMICR r <br /> G,VCSR 'J ITH STAFF TE=. lIEyDATUX r-QR .:.CSME j YES f I NOt 'RE=D) m s;—,,- .m—i m.STTCa FOA =-/ALJATIOM'YEj ilm21 I <br /> CA—,r-c REFERRED I / / DATE C..OSIIRE L_!T3 MAILM <br /> NAME OF <br /> E'/ALUATCR I <br /> 4.t 23 30 (UG-jWKSHT)\-4/9Q <br />