Laserfiche WebLink
SAN JOAOUIN-L LINTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL 099TH DIVISION <br /> 1. UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> A"' 01 FACILITY Diesel Per'COrry-w-ri CR 13WEEPS CODE I l 12 ri <br /> �(( t^,.ervxoyl 1 <br /> DORESS `-T • t-Y • �. Lfuck f" ANK ID N <br /> ANK SIZE 3 DEQ UEL TYPE �nl,:t <br /> II. GENERAL SITE HISTORY <br /> Is permit current? es0 ermit N acility Status Code $ i oc.Soil/GW Con es to <br /> +umber of Tanks at facilityl t ge of Tanks(if available) U Vlk ype of Tank teen brgl ngl Dual <br /> III. TANK HISTORY <br /> as Tank tested? es I INOIailed precision test ? es I IN01 If yes, give date(s) <br /> as a repair made to the tank system? 1Yas No f yes, what was repaired7 <br /> as repair done under inspection? as No ere soil samples analyzed? as I o TXE H-G H-D /EDB <br /> ype of failure/discharge atastrophiclong-term leakage verf ill noun ther: <br /> 1 10 <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received as o epth to Ground water k5ef/Year bw ;,2(o verage Annual Precipitation A= 4 10-25 <br /> -Site Wett(s) 1Yas o umber 8 Type Irr W I ub <br /> S I Score S Score 5 Score <br /> istance to Wells) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if o if <br /> R zondition R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> iniRtum Depth to groundwater from the Soil Sample (feet) 46-5-411 4d >100 1.100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) ID None • Unknown resent <br /> verage Annual Precipitation (inches) KXXXXX <10 9 10.25 Kxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration cn� <br /> f to (i.e., septic systems, water wells, ponds) None I Unknown resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> xxxxx None y one rr one <br /> COLUMN TOTALS>>>TOTAL POINTS ID t o'( * J A,? <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> 0- 18oppb <br /> T- 2dJ>o Pja2 B T X E B T X E <br /> K- g1_f04D VI7 MAXIMUM ALLOWABLE B•T-X•E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> -amy�Le Result: ASOLTNE 1000 100 10 <br /> TP -1 TP1F-d ��"O>Ce'' AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> 151 PP"` IZDPP6 IESEL 10,000 1000 100 <br /> OOTNOTES: ***If documented soil and/or ground water contamination 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. <br /> \3 Levels for BTXBE are not applicable at a TPH concentration of 10 ppn (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX 8 E or TPH Concentrations > Allowab a Levels Yes o <br /> I2. Recommend Site Closure 1Y es l �o l 11If Yes, Refer to Site Mitigation for Evaluation 10 <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE 'ES '0 EFERRED TO SITE MITIGATION FOR EVALUATION ES JO <br /> ATE REFERRED ATE CLOSURE LETTER MAILED <br /> AME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />