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SAN JOAQUIN COUNTY PL° [C HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION DATE <br /> UGST t 'HEET FOR SITE CLOSURE E'IALUAT ION <br /> SWEEPS%OOE <br /> NAME OF FACILITY <br /> 1 TANK 10 0 <br /> !ADORESSI QCT �D S ' 7G/ I�•/,� . <br /> TANK SIZE '7 CXA) FUEL TYPE je Lig <br /> GENERAL SITE HISTORY ••' <br /> FIs permit current? Yes No Permit tl Facility Sta�Code Doc.Soil/GV Cont Yes No <br /> Number of Tanks at facility Age of Ianks(if available) TSteel Fbrgl Sngl Dual <br /> III. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test 7 Yes No If yes, give date(s) <br /> ,Was a repair made to the tank system? Yes Rol I If yes, what was repeired? <br /> »as repair done under inspection7l Yes No Vere soil 'Wip s analyzed? Yes No aTXE TPM-G TPH-D� Pb/`E0a <br /> > of failure/discharge catastrophic long-term leakage over <br /> unknown other: <br /> <E+CVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes Na Depth to Ground Vater Ref/Year , <br /> Average Annual PrecipitationlA= 14 10-25 <br /> Cn-Site 'WeIL(s)I Yes No Nurber 1, type Irr Dom Pub S Score S Score S Score <br /> Distance to uell(s) frac Tank ft: ft% ft C 10 pts C 9 pts C 5fpts <br /> 0 if 0 it <br /> R condition R condition R condition <br /> V. Siva =eeture Leaching Potential Analysis <br /> = is met E is met E is .net <br /> Mi nimua Depth to groundwater from the Soil Sample (feet) <br /> >100 51.100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) <br /> None Unknown Present <br /> <10 9 10-25 xxxxxxX 26-40\2 <br /> Average Annual Precipitation (inches) xxxxzX <br /> Man-Made conduits which increase vertical migration None Unknown Present <br /> of leachate (i.e., septic systems, water wells, ponds) <br /> AL least More than <br /> (Unique site features: Recharge area, coarse soil, nearby wells. XXXXXX None / one one <br /> 7 .7 • • � � <br /> COLUMN TOTALS»>TOTAL POINTS y <br /> Sample Result: (3 i % OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 ptiT;less <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. HA\3 - <br /> 1GASOLINE1 1000 100 10 <br /> Sample Result: 1 <br /> MAXIMU?1 ALLOWABLE TPN LEVELS (PPM) DIESEL 10,000 1000 700 <br /> Fa�TPN <br /> FOOTNOTES: /"•If docurented soil and/or grand water contamination is present, do not cooplete the leaching potential <br /> �/ analysis. (i.e., site is currently on UGT Contamination List for soil or graced water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. <br /> qioC IC \2 If precipitation is > 40 inches, score 0 points. <br /> 1 y, \3 Levels for 3TX&E are not applicable at a TPH concen[rat ion of 10 ppm (gasoline) or 700 ppm (diesel). <br /> V1. AFF RECOMMENDATION/CONCLUSION ' ✓ }� I _ ^� �—nl k �h <br /> 1. Are 3TX 3 E or TPN Concentrations > Allowable Levels -Yes <br /> 2. Recomnerd Site Closure Yes No •lf Yes, Refer to Site Mitigation for Evaluation <br /> VI1. REVIEW EVALUATION - TO BE COMPLETED 3Y A SUPERVISCR/SENIOR <br /> CONCJR 'WITH STAFF RECCIWOENDATION FOR CLOSURE YES NO REFERRED 707=7! <br /> DATE REFERRED / / DATE CLOSURE LETTER MAI <br /> NAME OF <br /> EVALUATOR <br /> EN 23 30 (UGTWKSHT)\5/90 <br />