Laserfiche WebLink
SAN JOAOUIN NTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL H H DIVISION <br /> I , �UGST WORKSHEET FOR SITE CLOSURE EVALUATION .i ATE <br /> AME OF FACILITY C �,l ���� WEEPS CODE <br /> DORESS ANK ID Al <br /> TANK SIZE UEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> 1M <br /> Is permit current? es o ermit d acility Status Code oc.Soil/GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) ype of Tank feel Fbrgl ngl Dual <br /> III. TANK HISTORY <br /> :Ts Tank tested? es o ailed precision test ? as 0 If yes, give date(s) <br /> as a repair made to the tank system? Yes Nol f yes, what was repaired? <br /> as repair done under inspection? as 40 ere soil samples analyzed? es to T%E PH•G PH-D b/EDB <br /> Type of failure/discharge atastrophic long-term leakage verfill nknown 1 10cher: <br /> IV, REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received Ifas o epth to Ground Water of/Year verage Annual Precipitation = 4 10.25 <br /> Dri-Site wells) es o umber 8 Type Irr I ub <br /> S 3core S Score 5 Score <br /> Distance to Well(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R ondition R conditi on R ondition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inlmum Depth to groundwater from the Soil Sample (feet) ,100 1.100 25.50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) KAXXXX <10 9 10-25 KXXXXXX 26.40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown 3resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxxxz None one one <br /> COLUMN TOTALS»,TOTAL POINTS + + <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> 8 T % E <br /> MAXIMUM ALLOWABLE B-T•X•E LEVELS (PPM) 1 50 50 50 .3 .3 1, 1. NA\3 <br /> -ample Result: ASOLINE1000 100 10 <br /> A%IMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESEL 1 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 1=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 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION ,> ICS OjtFA --K( — <br /> 1, Are BTX 8 E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure IYes o If Yes, Refer to Site Mitigation for Evaluation <br /> VII, REVIEW EVALUATION • TO BE CCIMPLETED BY A SUPERVISOR/SENIOR <br /> -ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 I EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />