Laserfiche WebLink
SAN J0AO11 JUNTY PUBLIC HEALTH SERI VICS/ENVIRONMENTAL .TH DIVISION <br /> UGS' WORKSNE=, FOR SITE CLOSURE EVALUATTOI. DAT <br /> ':NAME OF FACILITY r _P ISWEPS CODE: <br /> jADORESSI /D? j S L Q.> <S-fl c- �� (TANK ID =I�9 �a 21,?- / <br /> 7 <br /> TANK SIZE( FUEL -YPEI G95ti2>✓.>-� -& (( „�• <br /> Ii. GENERAL S1TE HISTORY _ <br /> e - Faci lily Status Code) 9 IDoc.Soi L/GW Cont lyes INoI <br /> Is aermiT current. Yes No <br /> PermiT dtl <br /> Ntamer of Tanks at facility I (Age of TankS(if avai Lable) ,1(G lType of Tank lS:eelMFbrgl I Isngll Dual <br /> .... TANK HISTORY <br /> Inas Tank tested?IYes NoI (Failed precision test ?ITes INoI IIf yes, give daie<s)I'?/' <br /> 'I Was Waa repair made to the tank systaWlyes I No If yes, what was repaired?(i <br /> (Was repair done (aider inSPOCTion?I Yes I INoI IWere soil samples analyzed'IYesI INoI 6T)ET7H-G (TPN-D IPb/ED61 <br /> Itype of tai Lure/disehargel Icazastrephicl ILong-term leakage IawerfiLll unknawnl IoUer: j <br /> IV_ REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ;Soil Saaples ReceivedlYesl INoI Deoth to Ground Watery 01 11 �'� ; IAvera9e Annual Precipitationl A=I14 10-25'x. <br /> �On-Site WeLI(5)IYes INoI INL Type, lrrl IDo : IPubl <br /> S Scare S Scam S Score <br /> !Distance to Well(S) frau Tank) ft; f;; C 10 pa C 9 pts C 5 Pts <br /> 0 if C if 0 if <br /> R condition R cardition R condition <br /> IV. Site Feature - Leaching Potential Analysis E is met -n: is met E is met <br /> Mini(nm Death to groundwater trap the Soil Sample (feet) 140 I I >100 I 151-100 I 25-50\1 <br /> Fractures in S,,.0=ace (applies to foothills or vio=rain areas) 1 a I None Unknown lPresent <br /> Average Annual Precipitation (inches) Ixxxxxx (10 9 10-25 Ixpcaxxl 26-40\2 <br /> lMan-Made conoufts which increase vertical migration <br /> lot leachate (i.e., seatic systems, water wells, Ponds) None � Unknown Present � <br /> .Unique site features: Recharge area, coarse soil, nearoy wells. At <br /> 9 At Leas <br /> (poppal None on: More than <br /> 1 e one <br /> COLLNIN TOTALS>>>TOTAL POINTS III 1 7 <br /> I�Saiole ResuLt: (B T X OR E) RANGE OF TOTAL VOINTS149 pis or more I 11 - 48 pts 40 pts or less <br /> AID, <br /> T X E B T X E ' <br /> MAXI" ALLOWABLE B-T-X-E L__VE-S (PPM)( 1 50 50 50 3 3 1. <br /> All 1. NA\3 <br /> 'SawLe Result: GASOLINE 1000 I 100 10 j <br /> N n - __ TPH MAXIMUM ALLOLMBLE TPN LEVELS (PAM) DIESEEL 10,000 1000� 100 <br /> (FOOTNOTES: —If deamented Soil and/or ground wcontaminationater taminaiion is present, do not eom to the leaching potential <br /> analysis. (i.e., site is currcntty on UGT Contaminatim List for soil or groa>d wrier.) <br /> \i If depth is > 5 ft. and ( 25 ft., scare 0 points. If depth (--5 ft., do not use table. <br /> \2 If precipitation is ) 40 inches, Score 0 points. <br /> \3 LeveILs for BTX&E arc not applicable at a TPN oncentraii on of 10 ppa (gasoline) or 100 ppa (diesel). <br /> VI. STAFF RECOWENDATI0N/CONCLUSION <br /> 1. Are BTX Z E or TPH Concentrations > Allowadle Levels Ines) INo xI / / <br /> Z. Recanacnd Size Closure I Yes lNol I"lf yes, Refer to Site Mitigation for Evaluation ��lol IIP <br /> VII. REVIEW EVALUATION - TO BE COMPLc_TE9 BY A SUPURVI=—ENIOR 1 ✓y,`V <br /> CONCUR <br /> rWITH S'AF% RECOMMENDATION FOR COSUREl7ESl v INOI l TO SITE MITIGATION FOR EVALUATION I7ES IND <br /> (DATE REFEYREDI / / (DATE CLOSURE LETTER MAILEDI / / <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UG7LKSHT)\5/90 <br />