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SAN JOAQUIN TY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE, DIVISION 1 VGSSTrT WORKSHEET FOR SITE CLOSURE EVALUATION "" ATE 4 .2b. 92- AME OF FACTL ITY gi Valle Fcv, ClI EPS CODE DDRESS 520 5tnC k- MV-) ANK ID # gq, L123 -c) ANK SIZE a oU UEL TYPE 11. GENERAL SITE HISTOhy Is permit current? es o ermit # acility Status Code Ot� oc.Soil/GW Con e§ o Eumber of Tanks at facility) 4- ge of Tanks(if available) ype of Tank teel brgl ngl Dual 111. TANK HISTORY .as Tank tested? es o ailed precision test 7 as 0 If yes, give date(s) as a repair made to the tank system? es No f yes, what was repaired? ns repair done under inspection? as qo ere soil samples analyzed? as )o 13TXE PH-G PH-D b/EDO Ype of failure/discharge atastrophic Long-term leakage verfill nknown cher: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) oil Samples Received as I vlo epth to Ground Water :5 of/Year 1 5pr ; LIN verage Annual Precipitation k= 114 10.25 )n-Site Well(s) as o umber 8 Type Irr am ub S Score S Score S core istance to Wells) from Tank ft; ft; ft C 0 pts C pts C pts ' •0 if 0 if 0 'f R ondition R condition R ondition q. Site Feature . Leaching Potential Analysis E is met E is met E 's met inirtnm Depth to groundwater from the Soil Sample (feet) 95- 15,2P >100 1.100 O 25-50\1 ractures in subsurface (applies to foothills or mountain areas) None Unknown resent verage Annual Precipitation (inches) KXXMX 00 9 10.25 xxxxxxx 26.40\2 an-Made conduits which increase vertical migration f Leachate (i.e., septic systems, water wells, pords) ID None Unknown >resent Inique site features: Recharge area, coarse soil, nearby wells. G At least ore than xxxxx None 1 one one COLUMN TOTALS» 010>TOTAL POINTS 0 . L,J . O J�7 U ample Result: IS T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less 6 ND . ppw\ •T Tl B T IX JE B T I X E MAXIMUM ALLOWABLE B-T-%•E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 ample Result: ASOLINE 1000 100 10 •� A%IMUM ALLOWABLE TPH LEVELS (PPM) �' 3 TPHm IESEL 10,000 1000 100 COTNOTES: =--If documented soil and/or ground water contamination is present, do not complete the leach irg potential analysis. (i.e., site is currently on UST Contamination List for soil or ground water.) \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use cable. \2 If precipitation is > 40 inches, scare 0 points. \3 Levels for BT%8E are not applicabLe at a TPN concentration of 10 ppm (gasoline) or 100 porn (diesel). VI. STAFF RECOMMENDATION/CONCLUSION t. Are BTX 8 E or TPN Concentrations Allowable Levels Yes I2. Recommend Site Closure)Yes I -10 I �If Yes, Refer to Site Mitigation for Evaluation VII. REVIEW EVALUATION . TO BE COMPLETED BY A SUPERVISOR/SENIOR .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 ATE REFERRED / / ATE CLOSURE LETTER MAILED AME OF VALUATOR EH 23 80 (UGTWKSHT)\5/90 EH 29 80