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SAN JOAQUIN COSNTY ENVIRONMENTAL HEAOfH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITYITANK INFORMATION DATE: SITE/FACILITY NAME: Levand Family Trust STATUS CODE: ADDRESS: 47 East 19th Street CITY: Trac FA#: 29949 PR#: 0538004 TANK# 39 X7,17"]2 71 TANK SIZE: oo gat FUEL TYPE: Leaded gasoline II. GENERAL SITE HIS ORY Is Permit Current? LJYes ❑ No X-NA—not operating Documented Soil/GW Contamination?" ❑ Yes X No Number of Tanks at Facility 3 Age of Tanks(if available) 1900-1950s Type of Tank X Steel X Single III. TANK HISTORY Was Tank Tested?0 Yes❑ No X-NA Failed Testing? ❑ Yes ❑ No if Yes, Provide Dates: Was Tank System Repaired?❑Yes❑No X-NA If Yes, Describe Repair: X BTEX X TPH-G ❑TPH-D X LEAD Was Repair Done Under Permit?❑Yes ❑No X-NA Were Soil Samples Analyzed? X Yes ❑ No ❑EDB X OTHER_oxygenates Type of Failure/Discharge: ❑ Catastrophic ❑ Long-term Leak ❑ Overfill X Unknown ❑ Other IV. REMOVAL HISTORY Attach File Soil Samples Received? XYes ❑ No Seasonal High Depth to GW ft bgs Year/Reference zb [7i Onsite and/or Nearby Well(s)? ❑Yes"* S ❑ Irrigation: # Distance to Tank ft C Score 10 Score 9 S LI Domestic:# Distance to Tank ft 0 points if O points if 0 Score 5 points if ❑ Public: # Distance to Tank ft condition is condition is R condition is met E met � met E V. SITE FEATURE—LEACHING POTENTIAL ANALYSIS Minimum Depth to Groundwater from Soil Sample(feet) >100 01 51 -100 25-501 Fractures in Subsurface(applies to foothill or mountain areas) None Unknown Present Average Annual Precipitation(14 inches for SJC area) -------- <10 9 10-25 -------- 26-402 Man-Made Conduits which Increase Vertical Migration -------- None Unknown Present i.e.se tics stems,water wells,ponds) Unique Site Features: Recharge Area, Coarse Soil(coarse sands, None =AiLeastOne More Than One gravels),nearby wells Column Totals Total Points LD + + _ `LL TV Sample Results for BTEX: Range of Total Points 49 Points or More 41 —48 Points 40 Points or Less �-IU �s B 0'016 6-4-R Maximum Allowable BTEX B T E X B T E X NIA3 T Liaa�mple ar �forT � Levels(ppm) 1.0 50 50 50 0.3 0.3 1.0 1.0 Maximum Gasoline 1,000 100 10 Allowable TPH Diesel 10,000 1,000 100 I I z p 0 Levels m 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. 1 If depth is>5 feet and<25 feet,score 0 points. if depth is r5 feet,do not use table. 2 If precipitation is>40 inches,score 0 points. 3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. VI. STAFF RECOMMENDATION/REFERRAL/REVIEW 1. Are BTEX or TPH Concentrations>Allowable Levels? XYes 0 No 2. If No, is Site Closure Recommended? ❑Yes,i7No Completed By: T_Tu h Date Referred to Site Mitigation Unit for Final Actiont Reviewed By: Concur with Staff Recommendation ❑Yes El No b L47 [Date Closure Letter Mailed TAIL Cases are Referred to Site Mitigation for Final Action EH 23-0080(Rev 11114108)