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SAN JOAQUIN Cr f PUBLIC HEALTH SERVICES/ENVIRONMENTAL REAL 1IVISICN <br /> 1. f WORKSHEET FOR SITE CLCSIRE EVALUATION I DATE( _ <br /> NAME OF FACILITY �, c{�nY� Is`E"s COOEI l a <br /> IADDRESSI �_� !U .)., (TANK IO dl <br /> (TANK SIZE( a'?D (FUEL TYPE! - v <br /> [I. GENERAL SITE H[ ORY <br /> Is permit current? Yes <br /> No l Permit dI IFacility Status Code q 7lOpe.Sail/GW Cstr11 ? <br /> Yes <br /> murder of Tanks at facilityl Age of Tanks(if available)l� ?Type of TanklSteell IFbryll S^gLI OuaLI <br /> TANK HISTORY <br /> Was Tank tested?IYes l INo Failed precision :est ?I Yes INoI if yes, give date(s) I <br /> ''.as a repair made to :he tank system?IYesl Nol If yes, what was repaired?( <br /> ;Vas repair done under inspection?I Yesl INoI Were soil sales analyzeo?Iyes l INoI BnEI IiPX-GI TPH-O IPb/EOBI <br /> 'ype of failure/dischargecatastrophic Meng-term leakage? overrilll lunkmmetl lacier: <br /> IV. RE.NOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ,Soil Samples ReceivedlYesl No (Depth :o Ground Vater 3�IRef/Yearl (Average Arcual Preeipi tati enlA=l14 110-25 <br /> lCn-Site Well(s)IYes INp 1xiNumber & Typel Irr Orin IPubl <br /> S Score S Stora S Scare <br /> Distance :o Well(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if D if <br /> R condi rim i condition R condition <br /> V. Site Feature - Leaching Potential Analysis _ is mer E is met E is mer <br /> Minimlm Depth :o groundwater from the Soil Smoke (feet) >100 I 151-100 . 25-50\1 <br /> IV <br /> F^octures in subsurface (acpiies to foothills or mountain areas) 1 i t l None I l Unknown I (Present <br /> Ito <br /> Average Annuat Precipitation (inches) Ixzxxxxl <10 I 9 110-Z5 Ixxx=ml 26-4G\2 <br /> iman-Made conduits which increase vertical migration <br /> ''.of leachate (i.e., septic system, water wells, ponds) I l vane Unknown Present <br /> Junique site features. Recharge area, coarse soil, nearby weds. xxI At Least? More Chan <br /> xx <br /> x/x' Rona anal ane <br /> COLUMN TOTALS>» �)TOTAL POINTS V I I ' 0/ 1- 37 <br /> Samicte ResuLt: (B T X OR J RANGE OF TOTAL POINTS 149 pcs or mare I 41 - 48 pis I 4a pts or less <br /> Alt IVD 1 3 T % 3 T X 1 <br /> XAXIMA1 ALLOWABLE 3-T-X-E LEVELS (PPM) 1 Sol 50 5o .3 I.3 1.I 1. NA\3 <br /> -Sample Result: WSOLINE 1000 i 100 10 <br /> ^' MAXIMDI ALLOWABLE TPX I-EVELS (PPM) <br /> 'V TPN DIESEL 1 10,000 I 1000 I 100 <br /> F•-MTNOTES: —if doc aamad soil and/or ground voter contamination is present, do not complete zhe leadming <br /> analysis_ (i.e., size is currently on UGT Concminatim 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 cabLe. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> i <br /> \3 levels for 3TX&E are not applicable at a TPN cancencratien of 10 ppm (gasotine) or 100 ppm (diesel). <br /> VI. STAFF RECCPIMENDATICN/CC'NCLUSIOM <br /> 1. Are 3TX & E or TPN Concentrations > ALLowabie Levels I'Yesl Het <br /> xi <br /> 2. Recommend Site Closure Yesl Nol �'If Yes, Refer to Size Mitigation for Evaluation �.� / <br /> VII. REVIEW EVALUATICN - TO 3E COMPLETED BY A SUPERVISOR/= <br /> ION <br /> CCHCUR WITH STAFF RECCWEMOATICM FOR CLOSURE(YES( OI IREFERRED TO SITE MITIGATION FOR EVALUATIONIYES1 ',NO!, <br /> DATE REF51REDI / / 1DATE CLOSURE LETTER MAILED( <br /> NAME OF <br /> EVALUATCRI <br /> EH 23 80 (UGT4KSHT)\5/90 <br />