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SAN JOAQU19 ia, "PUBLIC HEALTH SER ICESIENVIRON NTAL HE LT! IVON <br /> I. t1GST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> ti. GENERAL SITE 01-STORY <br /> rri t crsrerst? x raft ani i ty latus C' Soi t1Ocont as o <br /> r;of TanEs at fscititl ge of TanLstif eves° ate o T feet ksr t <br /> n9t i)uot <br /> r t I. TANK HISTORY <br /> Tank test ailed preo si fest ? If yes, give date(s) <br /> as a repair to the tam sVst ? No des, ht repair <br /> os repair ci r irr otI ere sot des analy ed? es to TXE iii NxG rt0 b/1108 <br /> Ypo faittrreldiscrtare atastr is t to lakacJe veritlnown thor. <br /> , RE O AL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ,oat tel aeceiv o epth to Gro lrato 'eflYear * � erage Annuat Precipitation 10-25 <br /> -Site WOMS o r E T Ir uts <br /> S cora S core S core <br /> istan e to wetl ) Tarek ft; ft; ftC 0 pts C° pts C pts <br /> If Oif O f <br /> R ondition R andition R orxjftion <br /> Site feature . teaching Potential Analysis E is met f is met E t <br /> ini Depth to groundwater from the Soft Sanple (feet) >100 1.100 25 50 1 <br /> ractur°es In subsurface (applies to foothills or mountain areas) elf None Onrr res t <br /> verage Armat Precipitation (inches) sxxxx '10 9 10-25 KXXXXXX 26-40\2 <br /> An-Made conduits which increase vertical migration <br /> f tea hat (ine., septic system, crater welts, ponds) None Unknown IS resent <br /> tni ae site features. Recharge area, coarse soil, nearby sells. At least ore than <br /> xxxxx None one one <br /> COLUMN TOTALS—TOTAL POINTS + `" <br /> arcate Result. CS t X OR E) RANGE OF TOTAL POINTS 9 pts or mre 41 . 48;pts 40 pts or tss <br /> B T X E G T X E <br /> MAXIMUMM AL 1 so 5o 5 .3 .3 1 1, NA13 <br /> �Omle Result; A OLDIE 1000 100 10 <br /> AXIMUM ALLOWAII E TPN LEVELS CPPFI) <br /> PH IEE( 111,1100 1000 tOO <br /> OOTNOTES: ***If documnted soil for ground water contamination is present, do not coffptete the teaching pat tial <br /> a' t sisa (i.e. site is currently U TContamination List for soil or gr water.) <br /> 11 if depth is � 5 ft. and < 25 ft,, score O points'. If depth S ft., ego not use tabte< <br /> \2 If precipitation Is > 40 Inches, score 0 points. <br /> 13 Levels for RTX E are not applicable at a TPH concentration of 1 (Rasotine) or 1r0;pian. (diesel). <br /> VI. STAFF RECOWENDATIMCONCLdSION <br /> ' 1< i' STX E or ti Concontratisans � Altowatrl Levet Yes' o <br /> 2. Sita lasura ,es o !f Yes, Refer to Site F9iigatior� for Evdlat`t <br /> 1I< REVIEW EVALUATION - TO BEiC fPLETEO SY A SUPERVISOR/SENIOR <br /> *04CUR WITH STAFF RECORMENDATIOir FOR CLOSURE 'ES' 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> Tu <br /> ATE REFERRED 1 ATE CLOSURE LETTER MAILED <br /> AME Of <br /> .VALUATOR <br /> ER 23 80 (UGTWKSHT)15190 <br />