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SAN JOAOUIN COU461f PtJOLIC HEALTH SER' ICES/ENVIRON MENTAL HEALThw0it SION <br /> UGST KSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME Of FACILITY <br /> EPS CODE <br /> 00RESS ANK 10 µ. <br /> 3 <br /> tyj OANK SIZe <br /> It. CENERAL SITE HISTORY <br /> cont as <br /> Mgt D <br /> 111, TANK HISTORY <br /> ',is Tank test if yes, give (late(s) I <br /> as a repair repaired? <br /> is repair ri i i T as ere silts les arraalyzed? as 40 T PH-G P14-0 b/EDS <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPC4T FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> i <br /> Olt Samples Rece epth l Gr Mater ffYear erage Annual Precipitation 4 10-25 <br /> -Site welt($ <br /> S core S core S core <br /> Istance t iettts T ft, f T ft C 0 pts C pts C pts <br /> 0 0 if 0 <br /> R cmdition R andition R <br /> Site feature - Leaching Potential Anatysis E s met E is met E <br /> imix#-a Depth to gr water from the Snit' Sample (feet) >100 1-1 <br /> ractures In subsurface (applies to foothills or mountain areas) <br /> Iverage Annual Precipitation (inches) xxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an <br /> -made conduits which increase verticat migration <br /> f teachate (1.e., septic systems, water wetts, porxis) None Unknown resent <br /> Inique site features: Recharge area, coarse soil, nearby watts, At teast ore than <br /> xxxxx N*w one one <br /> COLUMN TOTALS>>>TOTAL POINTS <br /> ample Result: (0 T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> 8 1 X E 8 T X E <br /> MAX I FIL" AL 1 50 50 so .3 .3 1. 1. NA\3 <br /> 6;) <br /> oapte Resutt! SOLtFIE 1000 <br /> ;z AXIMUM ;RLL AISLE <br /> TAN <br /> 00THOTES; ***If documented soil and/or ground water contamination is present, do not cooptete the leaching <br /> Q <br /> a' Isis (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 tabte <br /> \2 if precipitation Is 40 inches, score 0 points. <br /> J \3 Levels for STNS E are not applicable at a TPN'concentration of 10 ppm (gasotire) or 100 ppm. (dieset). <br /> Vt. STAFF RECOMMENDAT I OWCONCLUS ION <br /> 2. R ' t Site Closcrre `es o �, tf yes, Refer o Site Ftitigatita� for E«rtuati <br /> V11. REVIEW EVALUATtON - TO SECOMPLETED BY A SLWIERVISORMNIOR <br /> EFERRED TO SITE MITIGATION FCR EVALUATION ES 0 <br /> LETTER=MILED <br /> ANE Of <br /> ER 23 80 (UGTWKS8T)\5/90 <br /> EH 29 80 <br />