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SAN JOAQUIN CC' ""' PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEA) DIVISION <br /> )• SEr(J) WORKSHEET FOR SITE CLOSURE EVALUATION �o;—" <br /> NAME OF FACILITY /L,'C�v`� S UPS <br /> DC- �`` / SWEEPS CODE /J! <br /> ADDRESS 3o0 3 E• !'�7CZy/� ✓/✓ , S QG 1� /s TANK ID #139 - 15-97 — o <br /> TANK SIZE tJ�� FUEL TYPE , a �/J <br /> II. GENERAL SITE HISTORY ��G�' <br /> Is permit current? Yes No Permit # - 1,5 P ' Facility Status Code Q a Dx.Soil/GW Cont Yes No �) <br /> Number of Tanks at facility Age of Tanks(if available) d Type of Tank Steel M Fbrgl Sngl Dual <br /> III. TANK HISTORY .S' �l Q Was Tank tested? N01 I Failed precision test 7 Yes No If yes, give date(s) 7/ 6 /97; <br /> Was a repair made to the tank system] Yes No If yes, what was repaired? 11t /&4'54-1 At <br /> Was repair done under inspection] Yes No Were soil samples analyzed? Yes No STXE TPH-G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes Quinber <br /> epth to Ground Water D Ref/Year &� Average Arcual Precipitation A-114 10-25 <br /> On-Site 4eLL(s) Yes No & Type Irr Dom Pub <br /> S Score S Score S Score <br /> Distance to Wells) from 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 �._ �j E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx I <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, ponds) None Unknown Present <br /> Unique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS 16 + + <br /> Sample Result:� (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> ^V <br /> / D B T X E B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 <br /> �/ 7� MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> '�I !✓ TPH DIESEL 10,000 1000 100 <br /> FOOTNOTES: ***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 BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> 'I. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels <br /> 2. Recommend Site Closure I YesI INoI �I*If Yes, Refer to Site Mitigation for Evaluation �u �ti <br /> LI. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR T-x�jf1 T7 <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES VtNOI REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> a DATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAMEOF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> s- Tc3. <br />