Laserfiche WebLink
SAN JOAQUIN C PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEA 'ISION <br /> WLYiKSHEET FOR SITE CLOSURE EVALUATIONDATE <br /> AS OF FACILITY SWEEPS CODE Z F /00 <br /> ADDRESS C. �L�i _ TANK ID 9 z� - �0o7�o%4'7, <br /> -TANK SIZE 6g )r Z FUEL TYPE <br /> II. GENERAL SITE HISTORY .•. <br /> lis permit current? Yes No Permit - Facility Status Code Doc.Soil/GW Cant Yes Ho <br /> Numher of Tanks a2 facility Age of Tanks(if available) Type of Rank Steel brgl Sngl Dual <br /> III. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test 7 Yes No If yes, give dates) / <br /> Was a repair made to the tank system? Yes Hol If yes, what was repaired? <br /> I 77 <br /> !Was repair done under inspection? Yes Nol ?Were soil samples analyzed? Yes No BTXE TPN-G TPN-D Pb/EDB <br /> type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water Ret/Year �� Average Arcual Precipitation A= 14 10-25 <br /> On-Site Wells) Yes No Number & Type Irr Dim Pub <br /> 5 Score S Score S Score <br /> Distance to WeLI(s) from Tank ft; ft; ft C 10 pts C 9 pis C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is mer <br /> Minimum Depth to groundwater from the Soil Sample Cfeet) >100 51-100 O 25-50\1 <br /> Fractures in subsurface (applies to foothills x ,mountain areas) None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxuxx 26-40\2 <br /> !Man-Made conduits which increase vertical migration None Unknown present <br /> lof leachate (i.e., septic systems, water welts, ponds) <br /> Unique site features: Recharge area, coarse sail, nearby wells. G At least More than <br /> xxxxx None I one one <br /> 1 COLUMN TOTALS»>TOTAL POINTS <br /> Sample Result: (8 T X OR E) RANGE OF TOTAL POINTS 49 pis or more I 41 - 48 pts 40 pts or less <br /> 130 f <br /> T` (n5a�i�rry B T X E B T X E <br /> �� ?pvaod E <br /> ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> 'Sample Result: <br /> GASOLINE 1000 100 10 <br /> MAXIMUM ALLOWABLE ? LE <br /> H VELS (PPM) 100 <br /> j Opp TPH —/_ DIESEL 10,000 1000 <br /> FOOTNOTES: "*If documented soil and/or grand water contamination is present, do not complete the Leaching potential <br /> analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth < 5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> 111. STAFF RECOMMENDATION/CONCLUSION <br /> l1. Are BTX & E or TPN Concentrations > Allowable Levels 'Yes No <br /> 2 Recommend Site Closure Yes Na �It Yes, Refer to Site Mitigation for Evaluation? <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SLA-aVISOR/S OR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSUREIYESI NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NOI <br /> DATE REFERRED / / iDATE CL E LETTER MAILED <br /> NAME OFl <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />