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SAN JOAGUIN COUNTY F HEALTH SERVICES/ENVIRONMENTAL HEALTH DI 1 -� <br /> UGST We..viWEET FOR SITE CLOSURE EVALUATION ATE 7, L77 <br /> >"E OF FACILITYt• EEPS CODE /S <br /> ,DRESS ANK ID <br /> A.NK SIZE C)o() UEL TYPE <br /> GENERAL SITE HISTORY <br /> s permit current7 es a ermit A acility Status Code oc.Soil/GW Cont es !o <br /> unber of Tanks at facility ge of Tanks(if available) Ype of Tank teel �Fbrgl I lL�ngI I Duall <br /> TANK 4ISTORY 111 L <br /> as Tank tested7 es o ailed precision test ? es o If yes, give date(s) <br /> as a repair made to the tank system? es No 1 11f yes, what was repaired7 <br /> ns repair done under inspection? ea No i gene <br /> soil samples analyzed? es !o TXE PH•G PH•D b/EDD <br /> ype of failure/discharge atastrophic long-term leakage verfill I mown Cher: <br /> ;EMC'✓AL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oii "Samples Received as I o eoth to Ground 'Water Z of/Year �b ; verage Annual Precipitation • 4 10.25 <br /> v+•site Wet L(s) es o Umber 3 Type Irr an b <br /> S core S Score 5 core <br /> Distance to vell(s) from Tank ft; ft; ft 0 pts C 9 pts C pts <br /> 0f O if 0 f <br /> R ondition R cor4ition R ondition <br /> Site Feature - Leaching Potential Analysis E �ia met E is met E •s met <br /> linimum Depth to groundwater from the Soil Sanple (feet) >100 1-100 25-50\1 <br /> 'roctures in subsurface (applies to foothills or mountain areas) f U None Unknown resent <br /> verage Annual Precipitation (inches) xXxx <10 9 10-25 KXXXXXX 26-40\2 <br /> 'nn-Made conduits which increase vertical migration <br /> it leachate (i.e., septic systems, water welts, ponds) None Unknown resent <br /> Inipue site features: Recharge area, coarse soil, nearby wells. At leas[ ore than <br /> Xxxx None One One <br /> COLUMN TOTALS»>TOTAL POINTS n L • - <br /> Iampl eTResult: (8 i_t OR 'c) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or les <br /> �.J <br /> 3 r x E B r x =. <br /> T �� X' 70 MAXIMUM ALLOWABLE O-T-X•E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: SOLINE 1000 100 10 <br /> I <br /> IMIJM ALLOWABLE TPH LEVELS (PPM) <br /> t � 0 0 TPH IESEL 1 10,000 1000 100 <br /> 'CCTHOT-c S: <"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 r_5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 levels for STXBE are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> . STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are 3TX S E or TPN Concentrations > Allowable levels Yes o <br /> 2. Recommend SiteClosure ea o ✓ If Yes, Refer to Site Mitigation for Evalua[ion <br /> 1. REVIEW ?VALUATION . TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE E5 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES !0 <br /> ATE REFERRED y`a'E CLOSURE LETTER NAILED <br /> l <br /> FrAVen .,+ I <br />