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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION G' <br /> I, UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITY K1n ,N�ln D0. (fin A-(V' SWEEPS CODE �-b� <br /> DDRESS 12. 1 L, ✓ N • Dem (e5 9�0L TANK 10 p 34- ZU T✓— OI <br /> TANK SIZE UEL TYPE <br /> 11. GENERAL SITE HISTORY *. <br /> Is permit current7 ks I o I ermit M I acility Status Code oc.Soil/GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) I LC4,(t,[Type of Tank teel r 9 1 ngl I"BGaI <br /> III, TANK HISTORY KV <br /> rcr^outd 3-25- 1 <br /> ,as Tank tested? as o ailed precision test 7 es o f yes, give date(s) <br /> as a repair made to the tank system? IYes No 1 1,f yes, what was repaired7 <br /> ns repair done under inspectian7 es No ere soil samples analyzed? as TXE -G •D b/EDO <br /> ypo of failure/discharge atastrophic long-term leakage verfill mown ther: <br /> IV. REMOVAL HISTORY (ATTACH INSPECT I N REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received as o epth to Ground Water Z5, of/Year I ; 16 '(7 verage Annual Precipitation = 4 10-25 <br /> )n-Site Wett(s) as 11o 1 4mber 8 Type ]rr I om I ub <br /> S core S Score S 3core <br /> istance to Well(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R ondition R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1-100 b 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None R Unknown resent <br /> verage Annual Precipitation (inches) KXXXXX <10 9 10-25 xxxxxxx 26.40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> lnique site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> xxxxx None R one h 2 one <br /> COLUMN TOTALS>>>TOTAL POINTS 369 + 6 3�, <br /> ample Result:r(B T X OR ) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> 'v D &�Pb� BT % E B I T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 1 50 50 .3 .3 1. 1. NA\3 <br /> 3amRle Result: ASOLINE 1000 100 10 <br /> A%IMUM ALLOWABLE TPH LEVELS (PPM) <br /> l ✓ PH1 IESEL 10,000 1000 100 <br /> OOTNOTES: ***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 <=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1, Are BTX 8 E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure 1Yes I o I If Yes, Refer to Site Mitigation for Evaluation Y <br /> VII, REVIEW EVALUATION • TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE 'ES 0 1 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF (�"` <br /> :VALUATOR ���/� <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />