Laserfiche WebLink
SAN JOAQUIN COUNTY .IC HEALTH SERVIC`_S/ENVIRONMENTAL HEALTH D' TON <br /> UGST tXiRKSHEET FOR SITE CLOSURE EVALUATION DATE <br /> ) � SLEEPS CODE <br /> ',ME OF FACILITY W1lll1 Cf/YYU TANK ID Y <br /> .ORE-SSI '5 /5 y G <br /> ANK SIZEI S50 FUEL PE - CC Ci7,�Q. Re -s <br /> f. GENERAL SITE HISTORY ep <br /> .s xrmi: current? Yes No Permit tl - Facility Status Code Doc.Soi l/GL Cont Yes No <br /> Tank Steel Fbrgl Sngl Dual <br /> Nunoer of Tanks at facility <br /> Age of Tanks(it available) Type of <br /> ,I, TANK 4ISTORY <br /> If yes, give date(s) / ! <br /> was Tank tested? YegiMPect!Gn? <br /> ailed pre:is ion fest 7 Yes INo ' <br /> was a repair made ttem? Yes No It yes, what was repeired?I <br /> Was repair done undYes No Were soil samples analyzed? YesNc STXETPN-G 7PH-DI Pb!`-OB <br /> Type of failure/disstrophic Long-term leakage) overfill unknam other: <br /> IV. REMCVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEAC41MG POTENTIAL ANALYSIS) <br /> Depth to Ground Water Ref/Year c Average An++a( Precipitation A- 14 10-25 <br /> Soil Samples Received Yes No Dep /} p� ' <br /> On-Site WeIL(s) Yes No Number i Type Irr Das Pub <br /> 5 Score S Score S score <br /> Distance to Wells) frac Tank '�1 yr ft: ft: ft C 10 pts CO 9tpts CC 5 PCs <br /> 0 if <br /> if <br /> R condition R condition R condition <br /> IV. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> eU�pQ <br /> IMinimm Depth to groundwater from the Soil Sample (fe �f��' S I >100 25-50\1 <br /> 51-100 <br /> more Unknown Presort <br /> Fractures in subsurface (applies to foothills or mountain areas) <br /> <70 9 10-25 26.40\2 <br /> Average Annual Precipitation (inches) <br /> xXXxzx xzxxXXX <br /> Man-Made conduits which increase vertical migration Mane Unknown L+ Presort <br /> of leachate (i.e., septic systems, water wells, Ponds) �J <br /> At least Mon then <br /> Unique site features: Recharge area, coarse soil, nearby wells. ro/ `{xzxx= None oone <br /> COLUMN TOTALS»>TOTAL POINTS [ V I • / 5 a3 1V <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 48 pts 40 pts or less <br /> -r= &t?i pm �'.7e 63 T X I E NA\3-- <br /> B T X E <br /> X MAXIMUM ALLOWABLE B-T•X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. . <br /> GASOLINE 1000 100 10 <br /> Sample Result: <br /> /' MAXIMLIN ALLOWABLE TP TPN LEVELS (PPM) DIESEL 10,000 1000 100 � <br /> 11g0 TPH—Gr <br /> ground water contamira <br /> FOOTNOTES: •'•If documented soft and/or ition 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 /> \i if depth is > 5 ft. end < 25 ft., score 0 points. If depth <a5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> ppm (gasoline) or 100 ppm (diesel). <br /> \3 Levels for BTUE are rot applicable at a TPN concentration of 10 <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are 3TX S E or TPN Concentrations > Allowable Levels •Yes No <br /> 2. Recommend Site Closure Yes No 'If Yes, Refer Lo Sita Mttigatian for Evalwtion <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> tEVALUATCR <br /> WITH STAFF RECpg1ENDATION FOR CIOSVR£ YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> RRED / /L / .-� DATE CLOSURE LETTER MAILED <br /> O , <br /> lJ�y� �jj��� �9 � y/� <br /> EM 23 30 (UGTVKSHT)\5/90 / Ale �,c/�� �/ ����(.�vr.2 CC <br />