Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HADIVISION <br /> / n UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> E OF FACILITY SP: ��7 WEEPS CODE <br /> DRESS C) J. �yylf>F'IC CIN ANK ID p Z <br /> "ANK SIZE i rno UEL TYPE IPSP <br /> GENERAL SITE HIS ORY <br /> Is permit current? es o ermit N - aciLity Status Code ! oc.SoiL/GW Cant es o <br /> umber of Tanks at facility ge of Tanks(if available) ?,2 ype of Tan teal FbrgL ngL Dual <br /> 111. TANK HISTORY <br /> Jas Tank tested? es o ailed precision test 7 es o1v If yes, give date(s) <br /> as a repair made to the tank syst em7 es No f yes, what was repaired? <br /> as repair done under inspection? as o ere soil samples analyzed? es o T%E I PH-G I PN-D I b/EDB <br /> Type of failure/discharge atastrophic long-term leakage verfill nknown ther: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es o epth to Ground Water j of/Year � �QSTo verage Annual Precipitation = 4 0.25 <br /> -Site WeLL(s) es o umber 8 Type Irr 01a ub <br /> S 3core S Score 5 core <br /> istance to WeLL(S) from Tank ft; ft; ft C 10 pts C 9 pts C i pts <br /> 0 if 0 if 0 if <br /> R ondition R condition R ondition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1.100 5 25.50L <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) xxxx <10 9 10-25 xmxmx 26-40,2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None 9 Unknown resent <br /> nique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxxx More one one <br /> COLUMN TOTALS»>TOTAL POINTS I + 3 6 + S y/ <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> d' 43fyAl XSSOnnPn,1 <br /> Y ?)P f' 8 T K E B T % E <br /> T yd. "^ PaM MAXIMUM ALLOWABLE B-T-%-E LEVELS (PPM) 1 50 SO SO .3 .3 1. 1. NA <br /> l <br /> ample Result: ASOLINE 1000 100 10 <br /> A%IMUM ALLOWABLE TPH LEVELS (PPM) <br /> /,W{J,pM TPH IESEL 1 10,000 1000 100 <br /> FOOTNOTES: `--If documented soil and/or ground 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 /> L If precipitation is > 40 inches, score 0 points. <br /> \33 Levels for BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX 8 E or TPN Concentrations > ALIo Le Levels Yes o <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES N 0 <br /> ATE REFERRED O / / r© ATE CLOSURE LETTER MAILED <br /> AME OF l <br /> "VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />