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SAN JOAQUIN C' Y PUBLIC HEALTH SERVICES/ENVIRC NTAL HEI aISION <br /> 1, UOST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME Of FACItT r ERS CODE <br /> DORE$ � � ANK lO <br /> ANt SIZE tit TYPE <br /> 11. GENERAL SITE HISTORY <br /> E roe rri t ur en T i t " as t i V Stat C S+ i t lGtP Cont es 0 <br /> r of Tanks a foaili )r ga F kSiif avalt te) of Tam test trr tn9t Duat <br /> 11:. TANK HISTORY <br /> ,as Tank test cision test as 0 if yes, give date($) <br /> as a repair to the tam s St T No I yes, what was repaired? <br /> AS repair ' u iss T3 7 sNo ere soft somptes gnat zed? es to TXE PN.G PNmO /EG <br /> YFao of foiture tliseliarife stastr fo tong-term leakage verfr"tl nknown ttfir: <br /> 8V. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAIL /COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> *II Samptes 9 96 verage Armat Precipitation 4 I .25 <br /> -Site welts ) es r S T Irr tela <br /> S core S Core S Core <br /> [stance to WetttS) f Tari ft ftt ft C O pts C; pts C pts <br /> `f' O if, O f <br /> R ondition R ondition R os<tita <br /> Site Feature » Leaching +otential Analysis E is met E is met E s t <br /> inims,n Depth to groundwater from the Salt Saapte (feet) >100 1.240 2S- dJ 1 <br /> raetures in subsurface (applies to foothitts or mountain areas) ,16 None UnE resent <br /> verage Annuat Precipitation (inches) xxx,xx 410 9 10-23 xxxxxxx 26-40\2 <br /> nm-Manm-Maae tondifts which increase vertical migration <br /> I leachate (i.e., septic System, mater welds, ) None unknown resent <br /> Inique Site features: Recharge area, Coarse snit, nearby welts. At least are than <br /> xxxxx None one one <br /> COLUMN TOTALS >>TOTAL POINTS <br /> anple Result: (a T X 04 E) RANGE OF TOTAL POINTS g pts or more 41 48 pts 40 pts or t ss <br /> II T X E S T X E <br /> 14AXIMUM ALLOWABLE 'CI-T-X-E LEVELS ! ) fi so so 50 .3 .3 1> 1. NA\3 <br /> ;ampte Resui t; ASOE INE 1000 100 10 <br /> AXIKJ14 ALLOWABLE TPH LEVELS (PPM) <br /> TPR (EBBE 10,000 <br /> 1041) 100 <br /> OOTNO ES: ***If documnted soft ardor gr tater contamination i present, eta not vorptete the teaching potential <br /> analysis. i.e. site Is currently can UGT Contamination List-for sail or ground grater. <br /> 1 It depth is > 5 ft. and < 25 ft., Store O pints. If depth <=5 ft., do not use table. <br /> 2 If precipitation is > 40 inches, store O points., <br /> t3 Levels for STXSE are not appti atate at a TPH>s centration of 10 PFM (Sasotine)' or 100 !these(). <br /> V . STAFF RECOWENOATION/CONCLUSION <br /> t, Ard RTX A E ar TPN ntratic > Atoadl Levelk Yes a w. <br /> R end Site Gloaters es o I Rs, Refer tra Site itigati `far Evluati <br /> VCs. REVIEW EVALUATION - TO SE C 4PLETED BY A SUPERVISOR SENIOR <br /> .CNCUR WITH STAFF RECOMMENVATtON FOR CLOSURE ES 0 ' EFERRED TO SITE MITIGATION FOR EVALUATION E$' O <br /> ATE REFERRED ATE CLOSURE LETTER MAILED <br /> AME OF <br /> .VALUATOR <br /> EN 23 80 UGTWX$HT)\5/90 <br />