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SAN JOAQUIN C&W* PUBLIC 14CALTH SEPYICESIERVIRONMENTAL REAL !VISION <br /> UT WORKSHEET FOR SITE CLO"f EVALUATICN ATE <br /> AME <br /> FACILITA7 • fps CE <br /> OF I <br /> X <br /> C C <br /> OGRESS c ANK 10 <br /> ANX $IZS UEL TYPE , <br /> 11. GENERAL SITE HISTORY <br /> :11. TANK HISTORY <br /> ,s Tank test es aatr l pre isi fest rs f yes, give date(s) <br /> as a repair repaired? <br /> AS repair irss pti T ere suit des analyzed? <br /> IV� REMOVAL HISTORY (ATTACK INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oi I swptts A verage Annual Precipitation 4 10.25 <br /> -Sitet( <br /> S core S core S core <br /> istance to Us C 0 pts C Pts C pts <br /> 0 if 0 If 0 <br /> R ondItion R ondition R ondition <br /> Site Feature - Leaching Potential Analysis E $ met E is met 6 s met <br /> inimiLa Otis to groundwater from the Soli Semple (feet) >100 1-100 0 25-5051 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annuat Pre tspit ation (inches) xxxx <10 9 10.25 xxxxxx 26-40\2 <br /> ,am <br /> -Made condufts aAlch increase vertical migration <br /> I leachate (1.e., septic systems, water wells, ponds) None Unknown resent <br /> Inique, site features; Recharge area, coarse soil, nearby wells. At least ore than <br /> xxxx None Oft one <br /> COLUMN T0TALS>>yTOTAL POINTS + A? + <br /> am to Resutt: (8 T A OR 1) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> 8 T X E a I x E <br /> MAXIKM ALLOWABLE 3-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. ( NABS <br /> *note Result: GASOLtNE 1000 100 10 <br /> IW4 ALL MILE TPN LEVELS (PPM) <br /> _TPN' XESEL 1O, tli4 1000 <br /> OOTNOTES: ***If doctsented soft and/or ground water contamination is present, do not comptete the teaching potential <br /> analysis. (i.e., site Is currently on UTContamination List,for soil or ground water.) <br /> \1 If depth is > 5 ft. and A 25 ft., score 0 points'. If depth ­5 ft., do not use table. <br /> \2 If precipfratlon is ;, 40inches, store 0 points. <br /> ° LA els fdr STS are t apPa Ica to t a TPH concentration of 10 ppm (gasoline) or 100 ppq (dieset). <br /> Vt. STAFF REC"ENOATION/CONCLUS ION <br /> 2. ' wrsd Site Clsre es c i` f Yes, Refer t Site fiitgati for Evl�sri <br /> oft. REVIEW EVALUATI04 - TO BE C04PLETED BY A SUPERVISOR/SENIOR <br /> #ONCUA WITH STAFF REG I)NMEN DATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED ATE CLOSURE LETTER MAILED <br /> AME OF <br /> CH 23 80 (UGTVXS1iT)\5/90 <br /> EH 29 80 <br />