Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> f. UC 'KNRXSHEET FOR SITE CLOSURE EVALUATION 20 <br /> 12 <br /> DATE 1� a <br /> NAME OF FACILITY J I SWci!PS CODE 10 ,515,5611 <br /> ACdRESS S w r TANK t0 tl •515 <br /> TANK SIZE 1500 FUEL TYPE �J <br /> It. GENERAL SITE HIS ORY <br /> Is permit currentt Yes No Permit 0 Facility Status Code Doc.Soil/GW Cont Yes No <br /> Number of Tanks at facility Z Age of Tanks(ff available) VVA Type of Tank Steel 1VOT, <br /> brgl Sngl Dual <br /> III. TANK HISTOR7 <br /> Was Tank tested? Yes No Failed precision test es No If yes, give date(s) <br /> IWas a repair made to the tank system? Yes No If yes, what was repaired4 <br /> Was repair done under Inspection? Yes No Were soft samples analyzed? Yes No 8TXE TPN-G TPH-D - Pb/EDB <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water 1 35r�of/Year 93; Vv I Average Annual Precipitation A-114 10-25 <br /> On-Site WeLL(s) Yea No Ntnber i Type I Irr Dom Pub <br /> 5 Score S ScoreS Score <br /> Distance to WeIL(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> IV. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Mini mm Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) O None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxzxxx 26-40\2 <br /> Man-made Conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water wells, ponds) �� None Unknown Present <br /> Unique site features: Recharge area, coarse Boit, nearby welts. At Least More than <br /> xxxxxxxx None �/ one one <br /> Cot" TOTALS>»TOTAL POINTS L� • 1� • 5 43 <br /> Sample Result: IS T XOOR E) RANGE OF TOTAL POINTS 49 pts or more 41 43 pts 40 pts or Less <br /> B� aD X ��1Y R T XE B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. U\3 <br /> Sample Result: TPN GASOLINE 1000 100 10 <br /> OD MAx11MAXIMUMALLOWABLE TPN LEVELS (PPM) <br /> DIESEL <br /> 10,000 1000 100 <br /> FOOTNOTES: "if documented soft and/or ground water contamination is present, do not complete the Leaching potential <br /> analysis. (i.e., site is currentty 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 /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTXLE art rot applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX L E or TPH Concentrations > Allowable Levels 'Yes No X <br /> 2. Recommend Site Closure Yes No If Yes, Refer to Site Mitigation for Evaluation <br /> V11. REVIEW EVALUATION • TO BE COMPLETED BY A SUPERVISOR/SENI <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOS(1RE YE NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATCR <br /> EH Z3 80 (UGTWKSHT)\5/90 <br />