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ALAL- <br />SAN JCACUIN LIC HEALTH SERVICES/ENVIRCHMENTAL HEALTH ICN <br />SHEET FOR SITE CLOSURE EVALUATION DATE b <br />NAME OF CF FACILITY t� �'" (SLEEPS CCOEI <br />fIAGORESSl Z,072—' TANX ID 31 - <br />4 TANK S I ZS 4,X I FUEL TYPE <br />i <br />!I. GENERAL SITE HISTORY <br />m <br />Is permit current? Yes No Permit 0 - Facility Status Code Doc.Soil/GW Cont Yes No <br />INuuber of Tanks at facility+ !® Age of Tanks(if available) Type of TanklSt t! Fbrgl I SVjAJ Dual <br />iii. TANK HISTORY <br />!Was Tank tested? Yesl INo failed precision test 2 Yes No IIf yes, give date(3)+ <br />Vas a repair made to the tank system? Yes AoAIf yes, what was repaired? <br />!Jas repair done under inspection? Yes INo <br />Iyer. snit saipies analyzed?IYesI INo( <br />STXE ITPH-GI ITPM-01 <br />I <br />Pb/EDB <br />q <br />;Type of failure/discharge <br />(catastrophic <br />tong -term Leakagel <br />overfill? unkno+anI <br />other. <br />tEMCVAL HISTORY (ATTACS INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FCR LEACHING POTENTIAL ANALYSIS) <br />Soil Samptes Received Yes NoI Depth to Graerd Vater <br />aef/Year <br />9 ; Average Arraml PrecipitationlA=I14 <br />10-z5 <br />IOn-Site Vett(s)Yes INo (Member & Type? IIrrI <br />Dcm <br />Pvb <br />S <br />C <br />0 <br />2 <br />_ <br />Score <br />10 pts <br />if <br />condition <br />is bet <br />(>100 <br />S Scare <br />C 9 pts <br />0 if <br />R condition <br />-e is met <br />I51-100 I <br />S <br />C <br />0 <br />R <br />- <br />Scare <br />S pts <br />if <br />condition <br />is met <br />125-50 1 �* <br />!Distance to Well(s) from Tank ft; ft; ft <br />�V. Site Feature - Leaching Potential Analysis <br />,?Minimum Depth to grouidwater from the Soil Sample (feet) <br />;Fractures in subsurface (applies to foothills or nounitain areas) <br />i None I <br />I UnkrXAM( <br />(Present <br />:Average Anrx4aL Precipitation (inches) <br />I <10 <br />9 110-25 jx===j <br />76-40`2 <br />.4m, -!lade conduits which increase verticat migration <br />of :eac�nate (i.e., septic systems, water wells, ponds) <br />i <br />I Aare <br />I UrJ= n <br />' <br />(Present <br />lUnigpe site features: Recharge area, coarse soil, nearby wells. <br />' <br />Mona <br />( ( <br />At least <br />one <br />more than <br />aye <br />ICCLtAIN TOTALS -,TOTAL ?DINTS <br />Sa=te 2esutt: (3 T X CR E) <br />RANGE OF TOTAL POINTS <br />49 pts or more <br />I 41 - 48 pts <br />I 40 pts or less <br />MAXIM X ALLO MU 3 -T -X -E UVELS (PPM) <br />1 50� 50' 50 <br />I .3 <br />.3 <br />( X.` E. <br />I AA\3 <br />�Samote Result: <br />TPN <br />MAXI"MAXI"IiABLE TPN LEVELS (PPM) <br />ALLC <br />GASOLINE <br />1000 <br />I0a <br />I 10 <br />DIESEL <br />10,000 <br />I= <br />I 100 <br />FCOTNOTEMS: "*If documented soil and/or groLs d water contamination is present, do not cemotate the leaching potential <br />!analysis. (i.a., site is currend w <br />tty an UGT Contamination List for soil or grocsater.) <br />\1 111 depth is > 5 ft. and < Z5 ft., score 0 points. it depth -5 ft., do not use tabta. <br />\Z 1f precipitation is > 44 inches, score 0 points. <br />\3 Levels for 3TX&E ars not apptieabte at a TPN concentration of 10 ppa (Sasotine) or 100 ppm (diesel). <br />111. STAFF RECOMMENDATION/CMCLUSICH <br />1- Are 3TX 1 E or IM Concentrations > Attoaabte Levels ('Yes+ INo' i <br />2- Reeanmerd Sita ClasurelYesl INo! ' If Yes, Safer to site Mitigation for Evatuatianf <br />'911. REVIEW EVALUATICN - TO 3E CCWt-':TM 3Y A SUP£2VISCR/SENICR <br />=NMR 'JITH STAFF RECD4IENDATICN FCR '-'CSURElYES# ANO' IREF-EUM TO SITE MITIMATICM FOR :9ALUATICWiY_SI INO' <br />OAT: REF -CARED] / / (DATE CL== LETTER MAILMI <br />(NAME :F <br />EVALUATCRI _ <br />:i 23 30 (UGT'JKSHT)\5/90 <br />