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SAN JOAQUIN C Y PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAL I ISION <br /> P: UST WORKSHEET FOR SITE CLOSURE EVALUATION ATC <br /> AME Of FACILITY EPS 000E <br /> EGRESS 52, ARK IO <br /> AHK SIZE VETYPE <br /> 11. GENERAL SITE HISTORY <br /> i rtr t srr: t s ca i t s i t i ty S st s i l/Gif cont es 0 <br /> r f Tsrss fsitilr Ss f Tsrrsii'f ssitAtrt ) TsrsR toot brqI not tlsast <br /> 1 1 s TANK HISTORY <br /> ,as Tank test If yes, Sive date(s) <br /> as a repair t f tors sYst N f fist r` it <br /> ns rir r i 3 t rr sii s tAs srrst+Ts s des TXE PH-G PR.O bIEGS <br /> APs fsa tr �riisChrG�r ststrr� ri t R-t tS vrf�t t r� rs' thr: <br /> Tye REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> it S Ess RH i s Pth Crab ft r f Y rrr 'v raf Annual, Precipitation 4 0.25 <br /> -Site tits r Tgae rr <br /> S Cars S Score S core <br /> istsrrte to WettfsT T ft# ftf f C 0 pts C pts Pts <br /> f 0 if O f <br /> R onditibrr R condition R �itirs <br /> Site Pasture - Leaching Potential Analysis E is met E is met E <br /> imim&m Depth to groundwater fres the Soil, Soopte (feet) >100 1-1OL1 2 50 1 <br /> rs tum s in subsurface (applies to foothills or mountain areas)` N UrrKr� r t <br /> verage Annual Precipitation (ihes) xxxxx 10 9 10-25 Kxxxxxx 26-40\2 <br /> am-made its which increase v rti st migration <br /> f leachate, (i.e., septic systems, water watts, porids> None Unknown � resent <br /> )nique site features: Recharge area, coarse soil, rrssrbyM salts. At least ore than <br /> xxxx N � (X* one <br /> COLUMN T0TA S ), T0tA1 INT * * <br /> smpts Result: i5 T X OR E3 RANGE OF TOTAL POINTS 9 pts or more 41 ^ 4S Tots 40 pts or toss <br /> S I X E S T A E <br /> MAXIMLIM ALLOWABLE 8-T•X.E LEVELS (RPM) 1 50 50 50 .3 .3 1, 1. ND <br /> A\3 <br /> P suit« A OLIRE 1000 100 10 <br /> AXIRJN ALLOWABLE TPN LEVELS (PPM) <br /> TP14 I SEL 10,000 1004 100 <br /> OOTROTES: ***If doctscentod soil r qr=4 water tontsmination is present, do not coaptete the teaching pat batt <br /> analysis. ti,e., site is currently on UGT Contamination Li t-fer soil or ground water.) <br /> \1 tf depth;is > 5'>ft. and � 25 ft., scare 0 pofnts. If depth **S ft., do not tsbte. <br /> If precipitation is > 40 inches, scare 0 points. <br /> \3 L vets for OTX&E are not spplI onic at s TPH concentration of 10 cum (Ss atige)_;ar 100 ; (Bisset):. <br /> V1. STAFF REC R ATION/C TCLt SIOri <br /> 1, EAr* STXE or TPH C ntratid A Altana le Levels2 Sate Ciasr s If Tis, Refer a Site litSsti for EvalUsti <br /> V11. REVIEW EVALUATION - TO SE CCMPLETED BY A SUPERVISOR/SENIOR <br /> ,OHCUR WITH STAFF RECOMMENDATION ftR CLOSURE ES EFERRED TO SITE LITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED ATE CLOSURE LETTER KAILED F <br /> AME OF <br /> ,VALUATOR <br /> ER 23 80 iUGT fK$HT)l j 0 <br /> H 29 80 <br />