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SAN :CACUtN CCLOne LIC REALTN SERVICZWE14VIRCHMENTAL 3EALT. ISICN <br />I. UGST '-CRZSHEET FCR SI -- CLOSURE EVALUATICH OATE� <br />NAME IF FACILITY I ` ISWEEPS =F-1 <br />IADORESSI ITAm7. ID $1 <br />ITANK SIZE I�2 C I FUEL TYPE 1 : e 3E, I <br />ti. GENE..RAL SITE 3ISTCRY <br />m <br />IIs Permit current?IY INaI Permit $1 - )Facility Status Cade- ,IOac.Soit/G'J CantlYes l Nol <br />INunber of Tanks at facility Aqe of Tanks(if avaitabte)l Type of Tank Isteel l Fbrgll ISngl1 Ouall <br />III. TANK 3ISTORY <br />was Tank tested? 'res INoI (Failed precision test ?IYesl INoI IIf yes, give date(s)l / / ; / / <br />vas a repair made to the tank system? 1YesI No <br />Iif yes, what was repaired?) <br />Inas ,-e-Mir Case Crider inspection? I Yes INo+ IYere sail samples anatyzed?IYes I INoI <br />STXEI ITP4-GI ITPH-01 IPb/sal <br />Type of failure/disctsarge (catastrophic) Ili -term leakage) overfill)o�I other: <br />Ct. .2£4CVAL RISTCRY (ATTACH INSP£CTICU REPORT FCR SITE OETAILS/CLLECT OATA FCR LEACHING POTENTIAL ANALYSIS) <br />(Soil Samples Recaivedlyesl INaI IDepch to Gracttd Vatarl/® efrear <br />IAver-age Arrumt PrecipitationlA=114 <br />Ila -as <br />Cn-Site14elt(s)IYes 1 INaI IMunber 4 Typal (Irrl (Dam Fwbl <br />S <br />C <br />O <br />Z <br />_ <br />Scare <br />10 Pts <br />if <br />condi t ion <br />is met <br />S <br />C <br />0 <br />Z <br />E <br />Score <br />4 pts <br />if <br />cosrf i t i on <br />is met <br />S <br />C <br />0 <br />Z <br />Scare <br />5 Pts <br />if <br />czeidi t i cn <br />is zet <br />Oistame to Well(s) fr= Taakl ft; ft; ft <br />V. Site 'eature - LeaG§ing Potential Analysis <br />IMinimum Oeptli to groundwater frim the Soil Sample (feet) Jt f- <br />I <br />>1c0 <br />I 151-100 <br />IFract:sres in subsurface (applies to foothills or mountain area I <br />I Nom <br />l 1 Unkmwn I <br />(Present <br />Average Arcual Precipitation Cinches) <br />I <10 <br />I 9 110-25 <br />Ixx==l <br />25-40\Z <br />Man -Mace carsaaits which increase vertical aigration <br />of leaezate (i.e., septic systems, water wells, pan's) <br />f Mae <br />Safaho+n <br />Present <br />(Unique site features: Recharge area, :.parse sail, nearOy welts. <br />Mahe <br />At least <br />ache <br />more theft <br />ane <br />Xx <br />I crLtaw TOTALS»>TOTAL POINTS <br />li <br />�$=to Iesutt: (3 T X CR E) <br />--• O < (3 <br />T - - ®• <br />RANK$ OF TOTAL PCtNTS <br />44 pts or more <br />l 41 - 43 pts I 40 Pts or less <br />MXIMX ALLCLUISL: 3 -r -1-e LEVELS (PPM) <br />1 <br />� 9.4 5a <br />1 50 <br />I .3 <br />Sampta Zesutt: <br />TPN <br />MAXI"ALLMMLS TPI LEVELS (PPM) <br />GASOLINE <br />tOQO <br />( 100 I 10 <br />DIESEL <br />50,000 <br />1 taco 1 t00 <br />FX)TNOTES: "w!f documented soil acid/or ;round water contamination is presant, do not a=leta the leae:hfnq potential <br />analysis. (i.a., site is currently on UGT Contaminstion List for sail or ground ':cater.) <br />\1 If dept's is > 5 ft. and < 25 ft., scare 0 points. if depth _S ft., do not lie tabta. <br />\2 If precipitation is > 44 inches, scan 3 Paints. <br />f \3 Levels for 3TXSE ate not appticacte ata TP4 concentration of 10 ppm (.9asotine) ar 100 Xm (diesel). <br />Vt. STAFF MCC44MAT1CM/=XCLUSICM 7 � <br />I1. Are 3TX b _ or TPH C.oncantrstions > Altowabte levels I''Yesi INo) <br />j Z. .2eeasmerad <br />site C:asun{Tes1 Mai If Its, 2efer to Sita Mitigation for "evaluation) <br />e <br />'/11. .1EVtEY :-VALUATICi - TO 3E COWt—ETED 3T A SUPSYISCRISE.VICR <br />CCN='JITH S'.AfF 2E'=9tENDAT CI FCR ==AEEYESj JNCJ IZEFVEM. TC SITZ MITIGATION FCR ?/ALUATICiIY_sf INC( <br />WE 1E=c3RE9I / / (DATE ^ ^ E .a, 'cit MIL.. I <br />(NAME .F <br />e /ALUATCR 1 f I n' , 1 � <br />