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SAN JOAQUIN ,tYY PUBLIC HEALTH SERVICES/ENVIRONMENTAL XEA.�IVISI <br /> `UST LARKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITY I �', ��, CORD ID 3 Ob <br /> DRESS ARK ID # 161 <br /> ANK SIZE UEL TYPE <br /> it. GENERAL SITE HISTORY <br /> IS permit current? as m o emit <br /> # - aciliry Status Cadejqq cc.SoiL/GW Cant es o <br /> umoer of Tanks at facility ge of Tank(if available), � �ype of Tank teem r-1 not Dual <br /> III. TANK HISTORY ' Y -rl <br /> Jas Tank tested? as o ailed precision test ? m 0 f yes, give date(s) <br /> as a repair made to the tank system? m No f yes, what was repaired? <br /> Jas repair done under inspection? as No ere soil samples analyzed? es o TXE PH-G PH-D /EDB <br /> ype of failure/discharge atastrophic long-term leakage verfill noun Thar: <br /> v. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETA'1S/ �Eg DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es o epth to Grovel Yater .5of/Year �& verage Arrw 1. Precipitation k- 4 0-25 <br /> -Site Well(s) m o umber & Type Irr om ub <br /> S crone 5 Sc.re S Scare <br /> istance to Wet((a) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R onditim R condition R ondition <br /> �. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sammote (feet),3ar,a >c73 >100 I 1-100 25-50�j_ <br /> Fractures in subsurface (applies to foothills or mountain areas) 110 1 more Unknown resent <br /> verage Annual Precipitation (inches) xxxx <10 9 10-25 Kxxxxxx 26-40',,2 <br /> Man-Made conauits which increase vertical migration <br /> bf Leachate (i.e., septic systems, water wells, Ponds) r ® None Unknown resent <br /> i <br /> �Jnique site features: Recharge area, coarse soil, or wells. At least ore than <br /> [Muxipal=>2000 it; domestic>500 it, irr/agricut tural=present] xxxxxx None me one <br /> COLUMN TOTAL'S'»>TOTAL POINTS ® ' I� ' I ✓ <br /> S�Ir ENc�.t: CS T OR ) Kg RANGE OF TOTAL POINTS 9 pts or more 41 - GS pts .40 pts or less <br /> { 6o5a +; ��� e T X E B 3 X E <br /> G 7S MAXIMUM ALLOWABLE B-T-%-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NAL <br /> Sample Result: LINE 1000 100 10 <br /> IMUN ALLOWABLE TPH LEVELS (PPM) <br /> N D TPN G IESEL 10,000 1000 100 <br /> FOOTNOTES: '"If docunented 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 c=5 ft., do not use table. <br /> \22 If precipitation is > 40 inches, score 0 points. <br /> _\3 Levels for STX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATi ON/CONCLUSION ry T <br /> 1. Are BTX & E or TPH Concentrations > Atlowable Levels Yes o K( <br /> Wesfrfie( .33h�� <br /> 2. Recommend Site Closure as o If Yes, Refer to Site Mitigation for Evaluation K� <br /> V11. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/LEAD SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / PATE CLOSURE LETTER MAILED / / <br /> AMEOF P1 <br /> `/0.LUATATOR <br /> EH 23 80 (UG7WKSXT)\5/94 <br />