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SAN :OACUIN CCUNTY HEALTH SERVICES/E4VIRCHMENTAL HEALTH D�N O— ^ <br /> rrA.4EEOF <br /> UGST�EET FCR SITE CLOSURE EVALUATICN ATE <br /> EEPS CCOE <br /> CILITY — AMM F/`G b /L� SANK ID 1 O �M Q QI <br /> D b�V UEL TYPE e5� 1 �j 37 <br /> :1. GE4ERAL SITE HISTORY <br /> Is permit current] as o ermit ! acility Status Code ac.Soil/GW Cant as <br /> o <br /> umber of Tanks at facility On v ge of Tanks(if available) 'C�(� ype of Tank teal XFbrgL I Dual <br /> It. TANK HISTCRY <br /> ns Tank tested7 es o ailed precision test 7 es o If yes, give dates) / <br /> as a repair made to the Cank system? as No f yes, what was repaired? <br /> was repair done under inspection? as o ere sail samples analyzed? esl G PH-0 b/EO8 <br /> Type of failure/discharge atastrophic long-term leakage vert ill nknawn Cher: <br /> V. REMOVAL HISTORY (ATTACH 14SPSCTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received as a epth to Ground eater of/Year :; veragePrecipitation = 4 0-25 <br /> Site WeIL(s7 es o utber S Type Irr an ubS e S core <br /> istance to Wells) from Tank ft; ft; ft C s C pts <br /> 0 0 if <br /> R ition R ordition <br /> V. Site Feature Leaching Potential Analysis Eac E 's met <br /> `.inimum Depth to groundwater tram the Soil Sample (feet) >100 1.100 25.50\1 <br /> ractures in subsurface (applies to foothills or mcun tain areas) None Unknown resent <br /> vcrage Annual Precipitation (inches) xxxx <10 9 10.25 xxxxxxx 26.40\2 <br /> I n-made conduits which increase vertical migration <br /> bf leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> n que site features: Recharge area, coarse soil, nearby wells. 11 At least ore than <br /> xzxx None one one <br /> COLUMN TOTALS»>TOTAL P0I4TS ' <br /> ample Result: (3 T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> 14 /JT B T % E <br /> ''rV <br /> /.� MA%ImLH ALLOWABLE B-T•%-E LEVELS (PPM) 1 50 50 SO .3 .3 1. 1. 4A\3 <br /> ASOLINE 1000 100 10 <br /> oracle Res lt• <br /> TAXIHUM ALLOWABLE TPH LEVELS (PPM) 100 <br /> TPH 1ESEL 10,000 1000 <br /> �OOLHOTES: ...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 grovel 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. pan (diesel). <br /> \ p3 Levels for 3TXSE are not applicable at a TPH concentration of 10 Ton (gasoline) or 100 <br /> . STAFF RECCFHE4DATICN/CCNCLUSION W/ 17 G n� <br /> 1. Are BT% 3. E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recommend SiteClosure es o if Yes, Refer to Site Mitigation for '. ation <br /> valu <br /> I. REVIEW EVALUATION • TO BE CCMPLETED BY A SUVERVISOR/SENICR <br /> _ONCUR WITH STAFF RSCCHME40ATION FOR CLOSURE SES 0 EF ERRED TO SITE 4ITIGATICN FOR EVALUATICN ES 0 <br /> ATE REFERREDIL�� ATE CLOSURE LETTER MAILEDy / <br /> IAME OF <br /> :VALUATOR J <br /> EH 23 80 (UGTWKSHT)\5/90 <br />