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SAN vACUIN =NTY I IC TH ScR'JIC:S/5N'!f?CYY.ENiAI 4E.M.4 o(ve .� _ <br /> UGST SHE.. FCR SITE CLOSURE EVALUAN N 1 ZD Gj Z <br /> CF =AC;L!TY I J��GO p1EEPS CCCE <br /> 2555 F 6V T h -f kt, I7ANX 10 x <br /> 5f;5 puEL TYPE Gj <br /> cVERAL SITE NISTCRY <br /> ;►rni t currenC7 iTes 0 I ermi C 4 I - A3ei L i Cy Status Code 19 �oe.Sai llGtl CcnC iYes �2o <br /> -ter of T3rics at facility I pge of iarks(if available) I iType of Tark r:eel Ifbr4l rql Ouall <br /> 'ANY 4ISTCRY <br /> Tark vested? es �l0 ailed Precision test t es �l0 I If yes, give date(s) <br /> a recair .made to the tank system? , es to f yes, what was r_pairea? <br /> re air done zx er inscec:ion? Hes �f0I :ere soil samples analyzed? Hes �o I iXE I �PH G P_PH-O b/578 <br /> of failure/discharge Latastraphic lorg-term leakage Pverfill kna+n I IO Cher: <br /> I <br /> '-OVAL HISTORY (ATTACH INs?ECTICH RE?CRT FOR SITE 'DETAILS/COLLECT OATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Samples Received Hes oI pepth :o Crocrd 'JaCer et/Year ) Average Arnual Precipitation <br /> ,ite 'Jell(s) yes I o lumber S Typel Ilrr cm ub <br /> S care S core S core <br /> :ante to vell(s) from Tark ft; ft; ft C 0 pts C PCs C fpts <br /> 0 if 0 if 0 <br /> R onditicn R ondiCian R ondicion <br /> Size Fea:ure - Leaching Potential Analysis c is met E is net E s met <br /> a.n 07 ty to grardwacer from the Sail Sample (feet) >100 I 1-100 I 125-5)\1 <br /> ;ores in subsurface (applies to foothills or =ntain areas) INcne I Unicno.n I present <br /> rage Arcual Precipitation (inches) xxx=x I <10 I 9 10-25 Ixxxzxzx 125-40\2 <br />-.n-made ccrcztits :hich increase vertical migration <br /> leachate (i.e., septic systems, water wells, ponds) ( None I I Unknown resent <br /> e site features: Recharge area, coarse soil, nearby wells. I I I At Leas-, <br /> aef iar than <br /> xxxx Mme II one <br /> CCLLuN TOTALS—TOTAL POINTS <br /> le Result (3 T X CR E) RANGc OF TOTAL POINTS 9 pts or more 41 - 43 atm I GO pts or less <br /> HAXIXLM ALLCUA3LE 3-T-X-E LEVELS (PPS) 1I 50 150 ( SC ( .3 .3 t. 1. 1 NA\3 <br /> vL a Result: ASCLINE 1C00 I 100 ( 10 <br /> AXI" ALLNABL'c TPH LEVELS (PPM) I <br /> TP4 IESEL 10,OCO I 1C00 100 <br /> ;INOTcs: "'If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> n <br /> aalysis. (i.e., site Is currently on UGT Contamination List for soil or ground water.) <br /> \1 If depth is > 5 ft, and < 25 ft., score 0 points. If depth <5 ft., do not use table. <br /> \2 If precipitation is > GO inches, score 0 points. <br /> \3 Levels for 3TXS'c are not applicable at a T94 concentration of 10 Ppm (gasoline) or 100 ppm (diesel). <br /> STAFF R£C:!V..E%4DATICN/CCNU JS1CH <br /> Are 3TX E or TP4 Corcentratiou > Allowable Levels Tes o <br /> Re^_ommrd Site Closure lyes o If Yes, Refer to Site Mitigation for Evaluation <br /> 1E'/fE'J EVALUATICN - TO 3E CCIPLETED 3Y A SL'PSRVISCR/ScN1CR <br /> =NC'R WITH STAFF RECCHPENOATICN FCR CLOSLRE SES 0 I EFERRED TO SITE MITIGATICH FCR EVALUATICH �tESI 0 <br /> .1I£ 1EF=tREO / / PATE CLOS.JR£ LETTER YAILEO y / <br /> _ I i <br /> trE Cf <br /> 'v AL 'A TCR <br /> i Z3 3a (ucr xSHT)%5/g0 <br />