Laserfiche WebLink
SAN ACAOUIN f TY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE <br />I, livo�-.1 WORKSHEET FOR SITE CLOSURE EVALUATION veno <br />DIVISION <br />OATEI <br />No ix <br />\\system)) <br />NAME OF FACILITY I 4d P7' <br />NoI <br />s <br />E <br />10-Z5 <br />IAODRESSI <br />d 651 S. <br />Air <br />Sfoe <br />TANK 10 <br />k -5'D60 <br />5'DG <br />Cm3 <br />6 <br />ITANK SIZE( FUEL TYPE D� t <br />11. GENERAL SITE HISTORY <br />overfill) <br />S <br />C <br />0 <br />R <br />F. <br />(unknown <br />Is permit current? <br />IYes <br />I <br />INo <br />V. Site Feature - Leaching Potential Analysis <br />(Permitk4qIIf <br />- ( <br />Facilit�yTStatus Codel <br />Doc..Sail/GW <br />ContI Yes <br />I 6 <br />No <br />Fractures in subsurface (applies to foothills or mountain areas) <br />Numer of Tanks at facilityl J(` <br />>iv KGL <br />1Age of tanks(if available) <br />Iw�,�S <br />IType of Tank l <br />Steel <br />lxIFCrgI <br />xxxxxxl <br /><10 <br />SngII <br />Owl <br />III. TANK HISTORY <br />iMan-Made conduits which increase vertical migration <br />!of leachate (i.e., septic systems, water wells, ponds) <br />None <br />(Was Tank tested? <br />Yes <br />No ix <br />\\system)) <br />Failed precision test ?Iyes I <br />NoI <br />A= <br />If yes, give dare(s) <br />10-Z5 <br />Was a repair made to the can//k <br />Yes Nol <br />If yes, what was repaired?I <br />(Number & Type <br />Was repair done under inspection? I Yes NoI (Were soil samples analyzed? I <br />Yes No <br />BTXEI ITPH-GI ITPH-0 Pb/EDB <br />Type of failure/discharge) (catastrophic long-term leakage <br />S <br />C <br />D <br />R <br />E <br />overfill) <br />S <br />C <br />0 <br />R <br />F. <br />(unknown <br />S <br />C <br />0 <br />R <br />'c <br />other: <br />!V. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br />Soil Samples Received <br />Yes <br />No <br />(Depth to Ground Water <br />of/Year) &6 (Average Annual Precipitation) <br />w <br />A= <br />14 <br />10-Z5 <br />�On-Size Well(s)I Yesl No <br />(Number & Type <br />IIrr <br />IDom l <br />IPubI <br />S <br />C <br />D <br />R <br />E <br />Score <br />10 pts <br />if <br />condition <br />is met <br />S <br />C <br />0 <br />R <br />F. <br />score <br />9 pts <br />if <br />condition <br />is .met <br />S <br />C <br />0 <br />R <br />'c <br />Score <br />5 pts <br />if <br />ccndition <br />is met <br />Distance to WeIL(s) from Tankl ft; ft; ft <br />V. Site Feature - Leaching Potential Analysis <br />Minimum Depth to groundwater from the Soil Sample (feet) 3 5 — 9 j�� <br />I >100 <br />I <br />I51 100 <br />I 6 <br />125-50\1 <br />Fractures in subsurface (applies to foothills or mountain areas) <br />I Q <br />None <br />I Unknown <br />I <br />(Present <br />Average Annual Precipitation (inches) <br />xxxxxxl <br /><10 <br />I 9 <br />110-Z5 <br />Ixxxxxxxl <br />26-60\2 <br />iMan-Made conduits which increase vertical migration <br />!of leachate (i.e., septic systems, water wells, ponds) <br />None <br />Unknown <br />Present <br />(Unique site features: Recharge area, coarse soil, nearby wells. <br />xxxxxx <br />None <br />7 <br />At Least) <br />one <br />More than <br />one <br />COLUMN TCTALS>))TOTAL POINTS <br />( I D <br />+ <br />+ <br />jSample Result: hD(9 T X OR E) <br />hi/ IV' . <br />RANGE OF TOTAL ?O [NTS <br />49 pts or more <br />41 - 48 pts I <br />40 pts or less <br />MAXIMA( ALLOWABLE 3 -7 -X -E LEVELS (PPM) <br />9 T X "c <br />1 50I SOI SO <br />B T X = <br />.3 .3 1. 1. <br />HA\3 <br />N1YµSamote 5� 7 - PI Mf?h;11 MAY IMM ALLOWABLE TPH LEVELS (PPM)GASOLINE <br />,I p <br />S OIESEL <br />1000 I <br />100 <br />10 <br />10,000 I <br />1000 I <br />100 <br />FOOTNOTES: " if documented soil and/or ground water contamination is present, do not complete the le potent <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 £t., 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 3TX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br />r1. STAFF RECOMMENDATION/CCNCLUSION C1,0G Ao�cvd p �Q/�QJ �'�y�%/��CQ�� <br />1. Are 9TX & -c or TPN Concentrations > Allowable Levels 'Yes) No b (�7b Q/��GnG(/ii12 `/ C <br />2. Recommend Site Closure Yesl NoI If Yes, Refer to Site Mitigation for Evaluation ���yryry�((� p�t.l' -S C� <br />112. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISCR/ IDR q O J <br />CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE( YES( NOI REFERRED TO SITE MITIGATION FOR EVALUATIONIYESI INOI <br />DATE REFERRED( / / (DATE CLOSURE LETTER MAID / / <br />OF <br />E4 23 80 (UGTWKSHT)\5/90 <br />