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SAN :OACUIN Cal APUBLIC HEALTH SERVICES/ERVIRCNMENTAL HEALTfISICN <br /> U '.CRKSHEET FOR SITE CLOS'RE _VALUATICN IN AIE I Z-Z6 'y Z <br /> NAME OF FACILITY I 4�G(° �. / Q i WEEPS CODE 16 -S- 7 <br /> i00RESS I ANK ID Y - <br /> ;IANK SIZE 0OJ UEL TYPE /Y5,- <br /> . GENERAL SITE HISTORY <br /> ids permit curren C7 es o ermit Y - acidity Status Code �� cc.Soil/GW Cont es !o <br /> auncer of Tanks at facility ) �1ge of Tanks( available) ✓ l' ype of Tank tee) brgl rgl DuaI <br /> I. TANK HISTORY <br /> �Uns Tank tested? es o ailed precision test 7 es o 1,,4f yes, give date(s) <br /> :as a repair made to the tank system? Fes No k4l yes, what was repaired? <br /> .as repair done under inspecticn7 I es o ere soil samples analyzed7 as o TXE PH$ PH-0 b/EDD <br /> "ype or failure/discharge atastrophic long-term leakage verfill noun cher: <br /> . REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECt DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received I as o epth to Ground 'dater 3% et/Year ':5&; verage Annual Precipitation = < 0-25 <br /> ]n•Si[e 'dell(s) es o uiber d Type Irr an ub <br /> S core S core S core <br /> 7istance to Wells) from Tank ft; ft; ft C 0 pts C pts C pts <br /> 0 if o it o r <br /> R endi tion R ondition R ondi tion <br /> J. Site Feature - Leaching Potential Analysis _ E is met E is met E s met <br /> iinia= Depth to groundwater from the Soil Saaple (feet) >100 1-10025.50\1 <br /> -ractures in subsurface (applies to foothills or mountain areas) Hone Unknown resent <br /> ,vcrage Annual Precipitation (inches) zxxx <10 9 10-25 xxxxxx 26.40\2 <br /> 'an-Made conduits which increase vertical migration Nq <br /> :F leachate (i.e., septic systems, water wells, pords) None ( Unknown resent <br /> nique site features: Recharge area, coarse soil, nearby wells. At least ) ore than <br /> xxxx None one 2one <br /> J <br /> COLUMN TOTALS>>>TOTAL POINTS I�' * a + ✓ I <br /> sample Result: <br /> IS T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> NAXIMLH ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 $o 50 .3 .3 1. 1. NA\3 <br /> ;ample Result: ASOLINE 1000 100 10 <br /> ni l AXIHUM ALLOUABLE TPN LEVELS (PPM) <br /> TPH IESEL 1 10,000 1 1000 - 100 <br /> COTHOTES: -**If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (f.e., site is currently on LOT 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 BTXSE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECOhHENOATICN/CCHCLUSION e,�f 0" e1 IC <br /> 1. Are BTX S, E or TPH Concentrations > Allowable Levels Yes o �7 �.�1;S .7X� m� G <br /> 2. Recommend Site Closure <br /> es Jo� If Yes, Refer to Site Mitigation for Evaluation <br /> . REVIEW EVALUATION - TO BE COMPLETED BY A SL'PERVISCR/SEHICR <br /> CONCJR WITH STAFF RECCHHENDATION FOR CLOSURE ES 0 I EFERRED TO SITE MITICATICN FOR EVALUATION i4ES O <br /> OATS REFERRED / / ATE CLOSURE LETTER MAILED { j <br /> LANE OF <br /> :'/ALUATOR <br /> CH 23 SO (UGTW%SHT)\5/90 <br />