Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> I. LOST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITY c. .h �p4 L),n Che -,-�q, ConoVi�P'�-& <br /> WEEPS CODE <br /> DRESS IV 3 G Chz v\V)e S{-, dip�W/ ANK ID N 2,D(O Z —Q <br /> ANK S12E CMEJV UEL TYPE I 6e—Se <br /> 11. GENERAL SITE HISTORY <br /> is permit current? es 1 o ermit p - acility Status Code oc.Soil/GW Cont as o <br /> umber of Tanks at facility ge of Ianks(if available) I oq <br /> Q ype of Tank teel Fbrgl ngl Dual <br /> 111. TANK HISTORY veow(/ (0'Z3 -a <br /> Jas Tank tested? es I IHOI ailed precision test 7 as o If yes, give date(s) <br /> Jas a repair made to the tank system? kes No f yes, what was repaired? <br /> as repair done under inspection? esF No ere soil samples analyzed? as TXE -G PH-D /EDB <br /> Type of failure/discharge atastrophic long-term leakage verf ill noun cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received eso Ltepth to Ground Water of/Year �� verage Amual Precipitation = 4 0-25 <br /> -Site Wells) as o umber 8 Type Irr am ub <br /> S core S tore S Score <br /> istance to Wel1(S) from Tank ft; ft; ft C 0 pts C Pts C 5 pts <br /> 0 1f 0 1f 0 if <br /> R ondition R ondition R :arid iti on <br /> J. Site Feature - Leaching Potential Analysis ,! E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) , 77''.)16 >100 1-100 25-5011 <br /> Fractures in subsurface (applies to foothills or mountain areas) `Q None Unknown resent <br /> verage Annual Precipitation (inches) xxxx <10 9 10-25 xxxmx 26-40\2 <br /> Ian-Made corxluits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown >resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> xxxx None ane 1s one <br /> COLUMN TOTALS>>>TOTAL POINTS r r `� 3 O <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> $X7 IJ p •2pQm B T X E B T X E <br /> MAXIML14 ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NAL <br /> angle Result: '�'K.lL SOL[NE 1000 100 10 <br /> (vy� IMUM ALLOWABLE TPH LEVELS (PPM) <br /> t N a)YN TPH IESEL 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 LOT Contamination List for soil or ground water.) <br /> L If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. <br /> 12 if precipitation is > 40 inches, score 0 points. <br /> 13 Levels for 8TX&E are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION C' evly ytne) �� YIO lMP <br /> 1. Are BTX 8 E or iPM Concentrations > lloweble Levels Yes <br /> I2. Recommend Site Closure fes o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> VALUATOR / /I `'� <br /> EH 23 80 (UGTWKSHT)\5/90 <br />