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SAN JOACUIN Cr"••TY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAL" DIVISION <br /> T WCRXSHEET FOR SITE CLOSURE EVALUATION DAT-cNoe <br /> NAME OF FACILITY SWEEPS COOE <br /> ADDRESS I Hr� N. rA,v\-I' o✓ 1 h `sfrrlc--I-Dvt cA ITAAr In s - OS I5(e5 <br /> TANK SIZE I DDD FUEL TYPE Lu.irJLDW II <br /> 1. GENERAL SITE HISTORY <br /> e» <br /> Is permit current? Yes No Permit N - Facility Status Code Doc.Soil/GW Cont Yes No <br /> Number of Tanks at facility LLy,,kM yV,.. Aga of Tanks(if available) up,•kjVw, Type of Tank Steel FbrgL Sngl Dual <br /> TANK HISTORY <br /> iWas Tank tested? Yes No Failed precision test 7 Yes No If yes, give date(s) / / I <br /> .Was a repair made to the tank systemR Yea No X If yes, what was repaired? <br /> Was repair done under inspection? Yes No Were sail samples analyzed? Yes No BTXE TPH-G TPH-D - Pb/EDB <br /> Type of failure/discharge catastrophic long-term teakage overfillix I unkrown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yea No Depth to Ground WaterL2641Ref/Yesr i ;1� Average Annual Precipitation A• 14 10-25 <br /> On-Site Welt(s) Yes No X( Nu ber i Type Irr Dom Pub <br /> S Score 5 Score 5 Score <br /> Distance to Wells) frac Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Minimun Depth to groundwater from the Soil Sample (feet) >100 51-100 E) 25-50\1 <br /> Fractures in subsurface (applies to foothills or Main areas) None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-Made conduits which increase vertical migration <br /> of Leachate (i.e., septic systems, water wells, panda) Nora Unknown Present <br /> Unique site features: Recharge area, coarse soil, nearby wells. At least Nor* than <br /> xxx)= Xone I ane ane <br /> COLUMN TOTALS»>TOTAL POINTS 3l� + ' 4 <br /> Sample Result: IS T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> �= �•5 0'j'A'2r 8 T X E B T X E <br /> T •� x��•� MAXIMUM ALLOUA13LE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result:2 400 Di GASOLINE 1000 100 10 <br /> -1J d$iXA't MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> DIESEL 10,000 1000 100 <br /> FOOTNOTES: —if documented soil and/or ground water cantamination 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. ppm (gasoline) or 100 ppm (diesel). <br /> \3 Levels for STXBE are not applicable at a TPH concentration of 10 <br /> `it. STAFF RECClWE40ATICN/CONCLUSION <br /> 1. Are BTX 3 E or TPH Concentrations > Allowable Levels 'Yes TN—o—x7 <br /> 2 Recommend Site Closure Yes No "< If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISCR/SENICR <br /> CCNCUR WITH STAFF RECCMWENDAT(CN FCR CLOSURE TES NO I REFERRED TO SITE MITIGATION FOR EVALUATICN YES XO <br /> DATE REFERRED / ., / .. DATE CLOSURE LETTER MAILED / / <br /> NAME OF <br /> EVALUATOR ' <br /> EH 23 80 (UGTWKSHT)\5/90 <br />