Laserfiche WebLink
' SAN JOAQUIN COI"- 'ELIC HEALTH SERVICES/ENVIRONMENTAL HEALTH-, ISICN r �c <br /> ism IkSHEET FOR SITE CLOSURE ,VALUATION DATE <br /> OF FACtL[TY ~ <br /> i �/ TAHK IO •��3 tj/O, — [� <br /> �Q ZE]S <br /> f <br /> ;AHK SIZE 0� FUEL TYPE GEHERA. SITE HI RY *•* <br /> Is permit current? Yes No Permit S Facility Status,Code Doc.Soil/GW Cont Yes Na <br /> 4unber of Tanks at facility Age of Tanks(if available) q Type�of Tank Steel Fbrgl Sngl Dual <br /> I. TAHK HISTORY <br /> has Tank tested? <br /> Y11!!11 No Failed precision test ? Yes No if yes, give date(s7 <br /> was a repair made to the tank system? Yes No If yes, what was repaired? <br /> was repair done under inspection? Yes No Here soil samples analyzed? Yes X Ho BTXE TPH-G TPH-D Pb/EDB �t <br /> P <br /> !Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> T FOR SITE DETAILS/COLLECT 9ATA FOR LEACHING POTENTIAL ANALYSIS)1. REMOVAL HISTORY (ATTACH IHSP_CT10N REPOR _ <br /> Soil Samples Received Yes Na Depth to Ground aster G Ref/Year ; <br /> Annual Precipitation An 14 <br /> Average <br /> 10'25 <br /> On-Site ;feLL(s) Yes N0 Number L Type Irr Don Pub <br /> S Score S Score S Scare <br /> t C 10 pts C pts C 5 pts <br /> Distance to Wells) from Tank ft; ft; fi <br /> 0 if -' 0 if Q if <br /> R condition R condition R condition <br /> E is met E <br /> v. Site Feature - Leaching Potential Analysis 51-100 <br /> met E is met <br /> 1-100 25-50\1 <br /> minimun Depth to groundwater from the $OIL Sample (feet) —b,100 51 <br /> Fractures in subsurface (applies to foothills or mountain areas) xxxxNone Unknown Present <br /> xx <10 9 10-25 xxxxxxx 25-40\2 <br /> Average A:,zwal Precipitation (inches) <br /> Man-Made ccr4uits which increase vertical migration None G unknown Present <br /> of leachate (i.e., septic systems, water wells, ponds) <br /> At least More than <br /> Unique site features: Recharge area, coarse soil, nearby welts. None one one <br /> xxxxxxCOLUMN TOTALS>>>TOTAL POINTS + 3(0 ; <br /> ii <br /> Sample Result: (3 T—�X, OR E) <br /> RANGE OF TOTAL POINTS 49 pts or., <br /> 41 - 48 Pts 40 Pts or less <br /> T Xl E B T X E <br /> o p�5 "0- MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. � <br /> 10 <br /> Sample Result: <br /> GASOLINE 10001 100 <br /> FAXlMUM ALLOWABLE TPH LEVELS (PPM) DIESEL 10,040 1000 100 <br /> 0 TPH <br /> it ***If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> FOOTHOTES: <br /> � <br /> analysis. (i.e., elle is currently on UGT Contamination List-for sail or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score o 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)/oorr 100 ppm (diesel.). <br /> 4' <br /> Vi, STAFF RECOMMENDATION/CONCLUSION , - <br /> J�piG'` -0 lig , <br /> 1. Are BTX b E or TPH Concentrations > All able Levels *Yes No +; <br /> es, Refer to Site Mitigation for Evaluati <br /> 2. Recommend Site Closure Yes Na *If Ton <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR 1 <br /> CONCUR JITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER FAILED <br /> NAME OF <br /> EVALUATORI <br /> EH 23 80 (UGTWKSHT)\5/90 <br />