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SAN jOAQUIN C(WTY ENVIRONMENTAL HEA j*HDEPARTMENT <br /> MENT <br /> UST WORKSHEET FOR SITE CLOSURE EVALUATION <br /> DATE: <br /> I. FACILITYlTANK INFORMATION <br /> NAME: Levand Famrl Trust <br /> STATUS CODE: <br /> SITE/FACILITY <br /> CITY: Trac <br /> ADDRESS: 47 East 11th Street <br /> FA#: 21941 PR#: 0538004 TANK# 39- <br /> TANK SIZE: V 11D cat FUEL TYPE: Leaded gasoline <br /> II. GENERAL SITE HISTORY <br /> Is Permit Current? ❑ Yes ❑ No X-NA-not o eratln Documented Soi11GW Contamination?` ❑ Yes X No <br /> Number of Tanks at Facility 3 Age of Tanks(if available) 1900-1950s Type of Tank X Steel X Single <br /> Ill. TANK HISTORY <br /> Was Tank Tested?❑Yes❑ No X-NA Failed Testing? ❑ Yes ❑ No if Yes,Provide Dates: <br /> Was Tank System Repaired?❑Yes El No X-NA if Yes, Describe Repair: X BTEX X TPH.G ❑TPH-D X LEAD <br /> Was Repair Done Under Permit?❑Yes Ll <br /> X-NA Were Sail Samples Analyzed? X Yes ❑ No ❑ EDB X OTHER_oxygenates <br /> Type of Failure/Discharge: ❑ Catastrophic ❑ Long-term Leak ❑ Overfill X Unknown ❑ Other <br /> IV. REMOVAL HISTORY Attach File { <br /> Soil Samples Received? X Yes Ll No Seasonal High Depth to GW :ft`1 bgsYear/Reference <br /> 00 <br /> Onsite and/or Nearby Well(s)? ❑Yes �(.No S S S <br /> Score 10 Score 9 <br /> ❑ Irrigation:Irrig # Distance to Tank ft C points if C p 0 points if. Score 5 points if <br /> Ll Domestic:# Distance to Tank ft O 0 s condition is met <br /> ❑ Public: # Distance to Tank ft R condition' R condition iR <br /> met E met E <br /> V. SITE FEATURE-LEACHING POTENTIAL ANALYSIS E <br /> >100 01 51 -100 25-501 <br /> Minimum Depth to Groundwater from Soil Sample(feet) <br /> Fractures in Subsurface(applies to foothill or mountain areas) to <br /> None Unknown Present <br /> -------- <10 9 10 25 <br /> Average Annual Precipitation(14 inches for SJC area) <br /> - -------- 26-402 <br /> Man-Made Conduits which Increase Vertical Migration ------- None Gj Unknown Present <br /> i,e.septic sstems,water wells, onds <br /> Unique Site Features: Recharge Area,Coarse Soil(coarse sands, l� None At Least One More Than One <br /> ravels), nearby wells <br /> Total Points + � + <br /> Column Totals (� <br /> Sample Results for BTEX: Range of Total Points 49 Points or More 41 --48 Points 40 Points or Less <br /> B ' Maximum Allowable BTEX B T E X B T E X N/A3 <br /> T �✓`"�6 •D 5 Levels(ppm) 1.0 50 50 50 0.3 0.3 1.0 1.0 <br /> E 31.4- 1-1•1 <br /> X <br /> Sample Results for TPH: Maximum Gasoline 1,000 100 10 <br /> FI"�I-�I 13T,—S Allowable TPH Diesel 10,000 1,000 100 <br /> S Levels m <br /> Footnotes: ***If documented soil and/or groundwater contamination is present,do not oompiete leaching potential analysis(i.e.site is already on the contamination list). <br /> If depth is>5 feet and<25 feet,score 0 points. If depth is-5 feet,do not use table. 2 If precipitation is>40 inches,score 0 points. <br /> Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. <br /> VI. STAFF RECOMMENDATION/REFERRAL)REVIEW <br /> 1. Are BTEX or TPH Concentrations>Allowable Levels? X Yes ❑ No 2. if No, Is Site Closure Recommended? ❑Yes 'No <br /> Completed By: �"Y.t Date Referred to Site Mitigation Unit for Final Actiont <br /> Reviewed By: Concur with Staff Recommendation ❑Yes ❑ No <br /> Date Closure Letter Mailed tAll Cases are Referred to Site Mitigation for Final Action <br /> EH 23-0080(Rev 11114108) <br />