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nS <br /> SAN JOAQUIN COUNT PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTIO VISION <br /> t;. UST WORKSHEET FOR WE CLOSURE EVALUATION ATE � <br /> ILIT EPS CCOE` <br /> AHK ID <br /> 1i= GENERAL SITE HISTORY <br /> i r3 xzra tT to raaai t a i l i ty Status Code oc.S0II/Gwcont <br /> r' f Tan a fs i t i : ga of Tonks(if available) ype of Tank tel Fbrg as t Dan t <br /> 111> TANK HISTORY <br /> 'as Tarn test If yes, give date(s) <br /> as a repair t t aric ayHt T N f sfast it <br /> ns repair d irrapaEti T er ars alit t o araatyx dT Ica TAE ri.G PR- b/EDD <br /> V ,� #adtUraldihiar aataRTphai t «t t �S vr°fill �a� rs tts �: <br /> 1y. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> it S40ptes R verage, Annuat Precipitation 0-25 <br /> ,site Welt() Tye Irr <br /> S cora S core S care <br /> itaraa to 6rRt!(AT fr Ta#riR ftt ftT ft C 0 pts C pts C pts <br /> O f O if 0 `f <br /> ot ondition A onditionR ondition <br /> Site Fatah - Leaching Potential Anatysis S met E: is met E S met <br /> inimium Depth to Sr water from the Saait Saopte (feet) >100 1-100 25-50\1 <br /> ra tames In subsurface (applies to foothilts or mountain areas> None Unknown resent <br /> verage Annual Precipitation (inches) xxxx x14 9% 14.25 xxxxxx 26-40N2 <br /> an«Made chits which increase vertical, migration <br /> T teachsate (i.e., Septic systms, seater welts, pons) None Unknown resent <br /> araique site features: Recharge area, coarse Soft, nearby wells. At '(eat rare than <br /> xxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS + + <br /> 23 <br /> to Result: (S T K OR E) RANGE Of TOTAL POINTS 9 pts or more, fat 48 pts 40 pts or less <br /> S T K E S T K E <br /> MAXIMUM ALLOWABLE DaT-X E LEVELS (PPM) 1 50 50 50 .3 .3 1. fie HA 3 <br /> ampteResult: AKOLINE 1000 104 10 <br /> AXIMUM ALLOWAGL:E TPH LEVE. (PPM) <br /> TAN IESEL 10,000 1000 100 <br /> GO IIOTE : If docuovnted staid, and/or ground water contamination is pr' Brat, do not comptete the teaching pot that <br /> analysis, (i.e., site is currently on UGT Contamination List-for suit or ground water.) <br /> �f 1 If depth is > 5 ft. and v 25 ft., $core 0 points. If depths <=5 ft., de not e table. <br /> 2 if precipitation is r 40 inches, score 0 points. <br /> \3 Leets for STK2E are not applicable at a T H concentration of 10 PPM (gasoline) or 100 (diesel). <br /> VI:a STAFF RECOWENDATIOt/C iCLU ON <br /> [1H� Aro 5Y E tar TI)H C Cratratatiras Attaal Levelsepi Sate C Cassa e es cr " If Yes, Refer to Site Mitigation for, Evsluati <br /> VIS. REVIEW EVALUATION TO SE COMPLETED DY A SU EPVISOR/SERIOR <br /> CNCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES O EFERRED TO SITE MITIGATION FOR EVALUATION ES O <br /> ATE REFERRED' / l ATE CLOSURE LETTER MAILED J / <br /> AME Or <br /> .VALUATOR <br /> ER 23 80 (UCTWKSHT)\5/90 <br /> H 29 80 <br />