Laserfiche WebLink
SAN JOAQUIN CONTY ENVIRONMENTAL HEA H DEPARTMENT <br /> UST WORKSHEET FOR SITE CLOSURE EVALUATION <br /> I. FACILITYrrANK INFORMATION DATE: " <br /> SITE/FACILITY NAME: Levand FamilyTrust STATUS CODE: <br /> ADDRESS: 47 Fast 11�Street CITY: Trac <br /> FA#: 21941 PR#: 0538004 TANK# 39— <br /> TANK SIZE: 1�50 o gat FUEL TYPE: Leaded gasoline <br /> ll. GENERAL SITE HISTORY <br /> Is Permit Current? ❑ Yes ❑ No X-NA—not oopperating Documented Soil/GW 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 /> III. TANK HISTORY <br /> Was Tank Tested?0 Yes❑ No X-NA Failed Testing? ❑ Yes ❑ No If Yes, Provide Dates: <br /> Was Tank System Repaired?❑Yes❑No X-NA If Yes, Describe Repair: <br /> X BTEX X TPH-G ❑TPH-D X LEAD <br /> Was Repair Done Under Permit?❑Yes ❑No X-NA Were Soil Samples Analyzed? X Yes ❑ No ❑ EDB X OTHER_oxygenafes <br /> Type of Failure/Discharge: ❑ Catastrophic Cl Long-term Leak ❑ Overfill X Unknown ❑ Other <br /> IV. REMOVAL HISTORY Attach File <br /> Soil Samples Received? X Yes L3 No Seasonal High Depth to GW ft bgs Year/Reference 7p !2 <br /> Onsite and/or Nearby Well(s)? ❑Yeslo S Score 10 S Score 9 S <br /> Ll Irrigation: # Distance to Tank ft C points if C Score 5 points if <br /> ❑ Domestic:# Distance to Tank ft O points if p <br /> ❑ Public: # Distance to Tank ft R condition is R condition is R trw cijo is met <br /> V. SITE FEATURE—LEACHING POTENTIAL ANALYSIS E met E met E r.ie r}Irk ik zop <br /> Minimum Depth to Groundwater from Soil Sample(feet) >100 , 51 -100 25-501 <br /> Fractures in Subsurface(applies to foothill or mountain areas) p None Unknown Present <br /> Average Annual Precipitation (14 inches for SJC area) -------- <10 9 10-25 -------- 26-402 <br /> Man-Made Conduits which Increase Vertical Migration -------- None Unknown Present <br /> i.e.septic sstems,water wells,ponds) <br /> Unique Site Features: Recharge Area, Coarse Soil(coarse sands, None At Least One More Than One <br /> gravels),nearby wells <br /> Column Totals Total Points 14� + 7j� + <br /> Sample Results for BTEX: Range of Total Points 49 Points or More 41 —48 Points 40 Points or Less <br /> SZz-� <br /> B �'ZI� Maximum Allowable BTEX B T E X B T E X <br /> T )��, NIA3 <br /> E 3$. 2 <br /> Levels(ppm) 1.0 50 50 50 0.3 0.3 1.0 1.0 <br /> X <br /> ample Results for TPH: Maximum Gasoline 1,000 100 .10 <br /> Allowable TPH <br /> Levels m Diesel 10,000 1,000 100 <br /> Footnotes: ***If documented soil and/or groundwater contamination is present,do not complete leaching potential analysis(i.e.site is already on the contamination list). <br /> 1 If depth is>5 feet and<25 feet,score 0 points. If depth is­5 feet,do not use table. 2 If precipitation is>40 inches,score 0 points. <br /> 3 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/REFERRALI REVIEW <br /> 1. Are BTEX or TPH Concentrations>Allowable Levels? XYes ❑ No 2. If No, Is Site Closure Recommended? ❑Yes No <br /> Completed By: T 'rgAn 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 />