Laserfiche WebLink
.ns Tank rested? es <br />SAN XACUIN <br />ClaiNTY AMC HEALTH <br />UGST 1WHEET FCR <br />SF RVICES/ENVtRCNHE4TAL HEALTH DI' ^I <br />SITE CLOSURE EVALUATICN <br />ATE zd CC Z <br />uA"E OF FACILITY I <br />NAVC61vi <br />f yes, what was repaired? <br />;as repair done under Inspection? Yes No) <br />EEPS CCOE <br />/ Z <br />`•ape of failure/discharge atastrophic <br />lcng-term leakage <br />loverfilt <br />ITANX <br />to x <br />- <br />LANK SIZE <br />UEL TYPE <br />S <br />C <br />0 <br />R <br />'c <br />Score <br />0 pts <br />if <br />condition <br />is met <br />S <br />C <br />0 <br />R <br />E <br />Score <br />9 pts <br />if <br />condition <br />is metE <br />S <br />C <br />0 <br />R <br />core <br />pts <br />f <br />ondition <br />s met <br />Istance to Wett(s) from Tank I <br />ft; ft; ' ft <br />- Leaching Potential Analysis <br />GENERAL SITE HISTCRY <br />>100 <br />( <br />.. <br />Is perait currentl ies <br />oIV <br />ermit - - <br />actltty Status Code <br />9 oc.Soit/GO Cenc es o <br />venter of Tanks at facility <br />ge of Tanks(if <br />available)I <br />Jr <br />ype of Tank feel <br />Fbrql <br />nql <br />Duall <br />t..vv VTerroV <br />an -Made conduits which increase verticat migration <br />f leachate (i.e., septic systems, water welts, ponds) <br />None <br />I <br />.ns Tank rested? es <br />o ailed precision test ? es <br />of <br />o <br />If yes, give date(s) <br />gas a repair made to the tank system? es <br />40 <br />f yes, what was repaired? <br />;as repair done under Inspection? Yes No) <br />ere soil samptes analyzed2 Yes o <br />TXE PH -G PH -0 b/EDS <br />`•ape of failure/discharge atastrophic <br />lcng-term leakage <br />loverfilt <br />I <br />lanknown <br />I lacher. <br />I rueeenrrnu oconor CrP SSTE OFTAILS✓COLLECT DATA PCR L`.AL111N4 rU1rx&i..&- A-6-441 <br />.ar <br />oit Samotes Received i es <br />of <br />epth to Ground 'Dater <br />of/Year, <br />11,verage Annual Precipitation <br />= 4 <br />0-25 <br />-Site Well(s)es <br />o <br />Lmber b Type <br />Irr <br />cm <br />tub <br />S <br />C <br />0 <br />R <br />'c <br />Score <br />0 pts <br />if <br />condition <br />is met <br />S <br />C <br />0 <br />R <br />E <br />Score <br />9 pts <br />if <br />condition <br />is metE <br />S <br />C <br />0 <br />R <br />core <br />pts <br />f <br />ondition <br />s met <br />Istance to Wett(s) from Tank I <br />ft; ft; ' ft <br />- Leaching Potential Analysis <br />rSitere <br />to groLr+dwater from the Sail Sampte tfeet) <br />>100 <br />1-100ubsurface <br />(applies to foothills or moLntain areas) <br />Rene <br />Unknown <br />resent <br />lverage Annual Precipitation (inches) <br />xxxxxx <br /><10 <br />9 <br />10-25 <br />�.xxxx <br />26-40%2 <br />an -Made conduits which increase verticat migration <br />f leachate (i.e., septic systems, water welts, ponds) <br />None <br />I <br />Unknown <br />I <br />resent <br />pique site features: Recharge area, coarse soil, nearby wells. <br />xxxx <br />None <br />At teas'. <br />ene <br />ore than <br />one <br />COLUMN TOTALS»,TOTAL POINTS <br />* <br />l <br />+ <br />I <br />r <br />ample Result: (3 T X OR E) <br />RANGE OF TOTAL POINTS <br />9 pts or more <br />41 43 pts <br />I 40 pts or less <br />MAXIMLH ALLCWAaIE 3 -T -X -'c LEVELS (PPM) <br />3 T X E3 <br />1 50 50 150 <br />.3 <br />T <br />.3 <br />X E <br />i. 1. <br />4A\3 <br />�ampte Result: <br />�AXIHUH ALLOWABLE TPH LEVELS CPPV) <br />TPH <br />ASCLINE <br />]000 <br />100 <br />10 <br />IESEL <br />10,000 <br />' 1000 <br />100 <br />COTHOTES: -If documented soil and/or ground water contamination is present, do not eanplete the teacning <br />analysis. (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 > 40 inches, score 0 points. <br />\3 Levels for 3TUE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (dieset). <br />. STAFF RECCWEYDATICN/CCNCLUSION <br />1. Are 3TX 3 E or TPH Concentrations > Allowable levels TTes o <br />2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br />I. REVIEW EVALUATICN - TO 3E CCHPLETED 3Y A SL'PERVTSCR/SENICR <br />f:ONCUR WITH STAFF RECCf"HENOATtCN FOR CLOSURE i.ES 0 EFERRED TO SITE 4ITICATtCN FOR EVALUATICN SES, O <br />ATE REFERRED PATE CLOSURE LETTER HAILED f I I <br />41n�E Of <br />i;vnlUAiOR <br />aH 23 d0 (UGTcxSHT)%5/1;0 <br />