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SAN JOACUIN COUNTY Pt -LIC HEALTH SERVICES/ENVIRCHMENTAL HEALTH 01% X314 <br />UGST WCRXSHEET FOR SITE CLOSURE EVALUATION ATE O <br />AME Of FACILITY — / EPS CCOE <br />nORESS 6 /J21 �7 G -[TANK 1D s Z t/`' 3 <br />TANK SIZESv��D S01 <br />UEL TYPE �i < <br />4ERAL <br />SITE Hf5IUHT <br />/\ ailed precision test 7 es <br />o <br />if <br />yes, give dates) <br />v <br />as a repair made to the tank system? as No f yes, what was repaired? <br />,is repair done under impaction? as o <br />ere sail samples analyzed? as o <br />TXE <br />ef:mlC <br />Nrf tnC? <br />as <br />b/E08 <br />o <br />Type of failure/discharge <br />ermit is acitity Status Cede <br />acastrophlc <br />OC.$sil/GV <br />Gant <br />es <br />O <br />er of <br />Tanks at leciLity <br />cher: <br />ge of Tanks(if available) <br />es <br />ype of Tank <br />teal <br />umber 3 Type <br />brgl <br />ngl <br />Dual <br />M TANK HISTORY <br />ns Tank tested <br />? as <br />o <br />/\ ailed precision test 7 es <br />o <br />if <br />yes, give dates) <br />/ <br />as a repair made to the tank system? as No f yes, what was repaired? <br />,is repair done under impaction? as o <br />ere sail samples analyzed? as o <br />TXE <br />PR -G <br />PH -0 <br />b/E08 <br />Type of failure/discharge <br />ail Samples Received as <br />acastrophlc <br />long-term leakage <br />verfill <br />nawn <br />cher: <br />ry REnVAL 41STORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA rat LEALaIau rw�ca��^w ^^^••-•-• <br />:. STAFF RECCMMENDATION/CCNCLUS ION <br />I. Are 3TX i E or TPN Concentration > ALL wable levels yes o <br />2. Recommend Si cc Closure des o If Yes, Refer to Site Hi- Igati for Evaluation <br />'I. REVIEW -EVALUATION - TO 3E COMPLETED A SUPERVISOR/ NIOR <br />OHCUR WITH STAFF RECOMMENDATION FOR CLOSURE iES EFERRED TO SITE MITIGATION FOR EVALUATION ES I 0 <br />)ATE REFERRED / / ///'''117 ATE CLOSURE LETTER MAILED' y / <br />'IAME OF <br />:`InLVA1OR <br />CH 23 313 (U(:TUKSHT)\5/90 <br />11 <br />to Ground Vater of/Yea <br />verage Arcual Precipitation isC <br />0-25 <br />ail Samples Received as <br />o <br />epch <br />Site 'Jett(s) <br />es <br />a <br />umber 3 Type <br />Irr <br />as <br />ub <br />5 <br />core <br />S <br />C <br />core <br />0 pts <br />S <br />C <br />care <br />pts <br />C <br />0 �l[t,, <br />p PCs <br />is tante co Well( from frac Tank <br />ft; ft; ` ft <br />O <br />R <br />E <br />ition <br />is c <br />O <br />R <br />E <br />L f <br />ondition <br />.m <br />is et <br />R <br />E <br />ordicion <br />s met <br />Site Feature leaching Potential Analysis <br />�. <br />'inimm Depth to grouedwacer from the Soil Saople (feet) <br />X100 <br />1-100 <br />25.50\1 <br />tracsures in subsurface (applies to foothills or mountain areas) <br />None <br />Unknown <br />resent <br />avcrage Arcual Precipitation (inches) <br />cxxxxx <br />10-25 <br />xxxxxx <br />26.0\2 <br />Han -Made conduits which increase vertical migration <br />resent <br />I leachate (i.e., septic systems, water wells, ponds) <br />4 a <br />'n <br />�nibve si;e features: Recharge area, coarse soil, nearby wells <br />C s• <br />are than. one <br />xzsx <br />NM <br />CCLUM TOTALS»>TOTAL POINTS <br />ample Result: CII <br />T� X OR e) <br />RANGE OF TOTAL POINTS <br />9 pts <br />or more <br />41 <br />- 48 pts <br />40 or less <br />T <br />X <br />E <br />B T <br />X <br />E <br />NA\3 <br />f1 <br />MAXI" ALLOWABLE 3-T•X•E LEVELS (PPM) <br />1 <br />50 <br />50 <br />50 <br />.3 .3 <br />1. <br />1. <br />SOLINE <br />1000 <br />100 <br />10 <br />ample Res c• S 0/, <br />10,000 <br />1000 <br />100 <br />114JM ALLOWABLE TPN LEVELS (DPM) <br />IE BEI <br />CONNOTES: ••-If documented sail and/or ground water contamination is present, do not complate the leaching pocen[ial <br />water.) <br />analysis. (I.a., site is currently on ULT Contmiration List for soil or grotrd <br />\1 If depth is > 5 ft. and < 25 ft., scare 0 points. If depth <:5 fc., do not use cable. <br />\2 If precipitation is > GO inches, score 0 points. <br />of 10 ppm (diesel). <br />ppm (gasoline) or 100 <br />\3 Levels for 3TXSE are rot applicable at a TPH concentration <br />:. STAFF RECCMMENDATION/CCNCLUS ION <br />I. Are 3TX i E or TPN Concentration > ALL wable levels yes o <br />2. Recommend Si cc Closure des o If Yes, Refer to Site Hi- Igati for Evaluation <br />'I. REVIEW -EVALUATION - TO 3E COMPLETED A SUPERVISOR/ NIOR <br />OHCUR WITH STAFF RECOMMENDATION FOR CLOSURE iES EFERRED TO SITE MITIGATION FOR EVALUATION ES I 0 <br />)ATE REFERRED / / ///'''117 ATE CLOSURE LETTER MAILED' y / <br />'IAME OF <br />:`InLVA1OR <br />CH 23 313 (U(:TUKSHT)\5/90 <br />