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Number of Tanks at facility f Tanks(if available) <br />ai Led precision test <br />r <br />LAM rf yes, what was repaired?' <br />4as a repair made to the tank sys <br />Pns repair done under inspection? <br />ZN <br />Type of faiture/discharge UA x It= WzP I M k?I �E E RKAI M <br />CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE <br />130201-ito Ground Water <br />�E FERRED TO SITE MITIGATION FOR EVALUATION <br />P0j:W:11:IAj:I1 <br />•Nwnvx!1146010MI. <br />re <br />9core <br />*Core <br />�istance to Wett(s) from Tank ft; ft; ft <br />pts <br />i <br />f pts <br />pts <br />if <br />f <br />�Iondition <br />ition <br />V. Site Feature Leaching Potential Analysis <br />!is met <br />�s met <br />,Winimum Depth to groundwater from the Soi I Sample (feet) 4o, io <br />ractures in subsurface (applies to foothills or mountain areas) <br />Iverage Annual Precipitation (inches) <br />Hnn-Made conduits which increase vertical migration <br />f leachate (i.e., septic systems, water wells, ponds) <br />4niqoa <br />ue site features: Recharge area, crse soil, nearby wells. <br />ore than <br />one <br />COLUMN TOTALS>>>TOTAL .s <br />-a <br />POINTS <br />Eample Result: (B T X OR E) RANGE OF TOTAL POINTS�49 pts or more <br />-7no <br />PPM <br />,MAXIMUM ALLOWABLE B -T -X -E LEVELS (� /�®�) <br />pte Result:i it it W <br />INM) <br />I. <br />WIMUM ALLOWABLE LEVELS (PP <br />TPH_& I oil <br />FOOTNOTE$: ***If documented soil and/or ground water contamination is pres nt, do not complete the Leaching potential <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 8TX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br />Are BTX & E or TPH Concentrations > Allowable Levels <br />ecommend Site Closure if Yes, Refer to Site Mitigation for Evaluation! <br />CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE <br />�E FERRED TO SITE MITIGATION FOR EVALUATION <br />P0j:W:11:IAj:I1 <br />00%TE CLOSURE LETTER MAILED <br />EH 23 80 (UGTWKSHTA5/9O <br />EH 29 80 <br />