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SAN JOAOJIN C4sw4Y PUBLIC HEALTH SERV C S/ENVJRON NTAL HSL 1VISION <br /> P, U05T WORKSHEET FOR SITE CLOSURE EVALUATION ATC <br /> AMR Of FACILITY r CPS CODE <br /> DOR ANX 10 <br /> ANN SITS UCi TYPO <br /> 11. GENERAL SITE HISTORY <br /> cont -as 0 <br /> a r taf Tanks at facility e Tarr s f" avail tte) Ter tie! erg! n9t OUat <br /> til, TANK HISTORY <br /> ,as Tank test i ailed preaisi test if yes, give date( ) d l <br /> as a repair ' cam the tangy cyst '? N Yes what was repair <br /> as repair ins c i ? Vs ere scalls las aral*ytedl es Is TXC Par. Pei-OI S <br /> Y� of faits�rea° ischaarge atastr� sic l gate lRakage verfitt ra n' thrr <br /> l < REMVVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OCTAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> fit S' les Receive epth to Grtr dater i Year - T � verage;A at Precipitation 4 10-25 <br /> -Site we tts) <br /> S core S Score 6 core <br /> Istance to Wettls) f Tarn ftI fti ftC 0 pts C pts Nr$ <br /> O .f O if 0 f <br /> R ondition R condition R ordition <br /> Site Feature - Leaching Potential Analysis S is met C is awt f $ m4t <br /> imimton Depth to groundwater from the Soil SaMte (feet) >100 1.1=00 25-50\1 <br /> ra tvres In subsurface (applies t foothitis or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) xxxxx <10 g 10.25 xxxxxx -40\ <br /> ran»Rade conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ) None Unknown S ' resent <br /> )nique site features: Recharge area, coarse soil, rtearby weits. At least ore than <br /> xxxxx N one <br /> COLUMN TOTALS TOTAL POINTS + + <br /> snpte Resuttc IS T X OR C) RANGE Of TOTAL PAINTS 9 pts Or more 41 , 48 pts 40 pts or lass <br /> Ii T X E S 1 X C <br /> MAXI ALiIASLC ii T X.C; LCyCL tPPff) 1 50 50 50 .3 .3 1. 1, N3 <br /> a ke ResUlt. AOtNC 1000 100 30 <br /> AXI ALLOi� SC TPH CyCLS tf�) <br /> TPH lSt 10, 00 :1000 100 <br /> OOTROT 5: ***If documented soil and/or ground easter contamination is present, do not coaptete the leaching potential <br /> analysis. i.e., site is currently on UST Contamination List for soil or ground water.) <br /> 1 if depth is s 5 ft< and e 25 ft., score 0 points. if depth <=5 ft,, do not use table. <br /> If precipitation is > 40 inches, sere 0 points. <br /> 3 Levets for STXSP are not appticabte at a TAP'concentration of 10 as k( ) tar 100 ppfrs (dieset). <br /> Vt. STAFF' RECOMMENDATION/CONCLUSION <br /> im Ara SX S C ar TSN ntt'akia All�watal Leuels Yes cr <br /> c^a Site CsUre ,es f YYas, Refer t Ss`ta ftitlgati �r Cvatati <br /> V11. REVIEW EVALUATION - TO SC COMPLETES BY A UPERVISOR/SENIO <br /> .ONCUR WITH STAFF RECOMMEROATIO14 FOR CLOSORE CS CF RCCB T SiTC FItTIGATS FOR iIA UAT`C3N SS' O <br /> 144W.11 ATR REFERRED ATC CLOSURE LC'TTRR iLCta <br /> ANS Of <br /> .VALUATOR <br /> CH 23 80 UGT tSHT)1 f 0 <br /> Eli 29 30 <br />