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SAN acACUIN PUBLIC HEALTH 5-awas/Es1VIRmmelTAL HEAL VISICH <br />1 WCRXSHE: T FOR SI i s CLOSURE VALUATION OATE I j _. 4 <br />iNAME OF FACILITY l ISciE_PS OXEt -7 zt <br />IADORESSI 8se f c r 19 ot ® i ` ITANK ID -41 -31 <br />(TANK SIZE, 10 IFUEL TYPEI , <br />II. GENERAL SITE HISTORY I � <br />Is .ermit cur r—�No �Permiit - iFacility Status Cadet IDoc.Soit/Ga Cant Yes l MCI 's <br />Nunoer of Tanks at factyl `Age of Tanks(if avaitabte)I IType of TanklSteet) IFbrgLl ISngtl OLLI I <br />TANK HISTORY <br />L;as Tank tested? IYes IMo' IFailed Precision :as. ?iYes i `MoI IIf yes, give date(s)) <br />'.as a repair rtade to the :tank systeartlYesl Noj IIf yes, mat was repaired?I <br />':as repair done under inspection?iYest INCI luere soil samates analyzed?IYes l IMCI STXEI <br />Type of failure/dischargei Icatastrocnicl (tong -term Leakagel Ioverfitll iunkmr-ml (other: <br />iV. REMOVAL HISTORY CATTAC3 INSPECTION FOR Sit= DETAILS/COLLECT DATA FOR tEACiING POTENTIAL ANALYSIS) <br />ON REPO <br />TPH-01 I Pb/SS i <br />Soil Samotes Receivediyesl iNol (Depth to Ground Waterl IRef/Yearl (Average Annual ?rxipitationiA=I14 <br />, <br />I10 -25I <br />On -Site 'aetL(s)IYes I IN.oI INtanber Typel IIrri IDomI lei <br />S <br />C <br />D <br />R <br />-e <br />Score <br />10 pts <br />tT <br />(condition <br />Its :net <br />S <br />C <br />Q <br />R <br />Score <br />9 pts <br />if <br />condition <br />is met <br />S <br />C <br />Q <br />R <br />Scare <br />5 Its <br />if <br />condition <br />is met <br />jDistanca to 'lell(s) from T i ft; ft; <br />Iv. Site Feature - Leaching Potential Analysis <br />IMinimun Depth to groundwater from the Soit Smote (feet)30 <br />i ' >Ice <br />i p51-100 i I ee..-50\1 <br />IF^actures in subsurfaea (aepties to foothitls or motain areas) <br />1 I Moate <br />I I Unknown i (Present <br />lAver3ge AnnuaL Precipitation (inches) <br />IXxxxxxl <10 <br />I 9 110- S <br />ix:wou'cxl <br />'Man -,Made conduits whicil iaxrease vertical migratiot <br />!of :eschate (i.e., septic systems, water weds, Ponds) <br />Yate <br />` i Jnkrown ! pPresent <br />Wnicue site features: Recharge area, coarse soil, nearby veils. <br />I=o=l <br />Nares <br />I <br />+ At teasel <br />I �,e <br />more than <br />I one I <br />COLUMN TOTALS»>TOTAL POINTS <br />a <br />!l <br />jSarticle 2esutt CS t X OR =) <br />11 <br />RANGE OF TOTAL MLMTS <br />49 pts or mare I 1.1 - 4a pts 40 pts or less <br />MAXIMUM ALLOYASL£ 3 -T -X -i_= LEV LS (pPM) <br />3 T I X <br />1, zdi 50� <br />_ <br />50 <br />31 <br />} 3 <br />�` X1 _I ` <br />.3 11. t. MA\s' <br />:Samote Resutt: <br />TPH <br />MAXINN;)M ALLOYASLE TPH LEVELS (PPR) <br />I GASOLINE <br />1000 I 100 I i0 <br />DIES? <br />i0,GDD i 100o I Soo I <br />i <br />PCOTNOTES: `''"'If ed soil and/or gronx>d water contamtination is presestt, do not ==tat* roe Leacttng Por= --14L <br />anatysis. (i.e., site is cur.entty on IGT CaTcamination List for soil or ground water.) <br />i \1 if depth is > 5 ft. and < 75 ft., scare 0 mints. If depth c5 ft., do not use able. <br />\2 If precipitation is > 40 inches, scare 0 points. <br />\3 Levets for 3TX&E are not appticabte at a TPN =xxmmTazjCn of 10 ppm Cgasotine) or 100 ppm (diese!)- <br />VI . STAFF RECOMMENDATICN/C RCLUSICM <br />1. Are 3TX 3 E or TPH Concattrations > ALLowabte Levets I"Yes4 IMoI I <br />i <br />MCI xif Yes, Refer to Site Mitigation for _valuation <br />?. ReComner+d Site ClasuselYe3 <br />VII. REVIEW EVALUATION - TO 3E CCMPL_ETE'D 3Y A Wc-RVISOR/SOICR <br />CNCUR WITH STAFF RECOMMENDATION FCR C..OSUREIYESI (Mai f REFERRED T13 SITE '4ITIGATiON FOR EVALUATICNIYESI NO <br />DATE REFERRED / / JOATE CLOSURE L.'TT"ER 4AILE-31 <br />NAME OF <br />EVALUATCRI <br />=11 ?3 80 (UGTUKSHT)\5/90 <br />