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SAN JOAQUIN CO PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAL' 'ISION I. Ut.% =KSHEET FOR SITE CLOSURE EVALUATION DATE NAME OF FACILITY �O SWEEPS CODE y3 /00 (ADDRESS C �L�i TANK [D TANK S I Z )r Z FUEL TYPELp it CFwERAI crTF NTSTneY --------- __._ s permit current? Yes No M Perpit # - Facility Status Code DOc.SOi L/GW Cont Yes No urtber of Tanks at facility Age of Tanks(if available) Type of Tank Steel brgl Sngl Dual Was Tank tested? Yes No No Depth to GrounAlrWaterRelflYear Failed precision test 7 Yes Average Annual Precipitation No If yes, give dates) On -Site Wells) Was a repair made to the tank system? I�Was Yes No If yes, what was repaired? Number 8 Type repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE I TPH-G TPH-D Pb/EDB Type of failure/discharge catastrophic long-term leakage overfill unkno�m S C other: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING runtN uAC A L u.>i Soil Samples Received Yes No Depth to GrounAlrWaterRelflYear �� Average Annual Precipitation A-114 10-25 On -Site Wells) Yes No Number 8 Type S C score 10 pts S C Score 9 pts S C Score 5 pts Distance to Well(s) from Tank ft; 0 R E if condition is met 0 R E if condition is met 0 R E if condition is met V. Site Feature - Leaching Potential Analysis Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 O 25-50\1 Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 Man -Made conduits which increase vertical migration None Unknown Present of Leachate (i.e., septic systems, water wells, ponds) Unique site features: Recharge area, coarse soil, nearby wells. None G I At least one More than one xxxxxxj 31� + _ COLUMN TOTALS»>TOTAL POINTS + 40 pts or less Sample Resu t: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts E= �/ia�/> ti B T X E 8 T X E 6s XY% ?yscv MAXIMUM ALLOWSLE B -T -X -E LEVELS (PPM) i 50 50 50 3 .3 1. 1. NA\3 'Sample Result: GASOLINE 1000 100 10 1000 100 � MAXIMUM ALLOWABLE TPH LEVELS (PPM) DDO TPN DIESEL 10,000 FOOTNOTES: ***If documented soil ardor ground water contamination is present, do not complete the Leaching potential water.) analysis. (i.e., site is currently on UGT Contamination List for soil or ground \1 If depth is > 5 ft. and � 25 ft., score 0 points. If depth 45 ft., do not use table. \2 If precipitation is > 40 inches, score 0 points. ppm (gasoline) or 100 (diesel). at a TPN Concentration of 10 ppm \3 Levels for BTXBE are not applicable /ll — nn._ V1. STAFF IEC OMMENDATION/CONCLUSION i 1. Are BTX 8 E or TPH Concentrations > Allowable Levels *Yes No 2. Recommend Site Closure Yes No If les, Refer to Site Mitigation for Evaluation VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/S OR CONCUR WITH STAFF RECOMMENDATION FOR CLOSUREIYES NO REFERRED TO SITE MITIGATION FOR EVALWLT ION YES NO DATE REFERRED / / DATE CL!n LETTER MAILED NAME OF % - i A n EH 23 80 (UGTWKSHT)\5/90