Laserfiche WebLink
SAN JOAQUIN COUNTYIC HEALTH SERVICES/ENVIRONMENTAL HEALTH Of ON y C. <br /> UGST JWHEET FOR SITE CLOSURE EVALUAT ICN DATE /y /c-? <br /> SWEEPS CODE <br /> rE CF FACILITY <br /> )RESSI �� �c<ir $ a Lq �/m TANK i0 <br /> NX SIZE IFUEL TYPE <br /> GEHE.RAL SITE HISTORY .. <br /> permit cur rend Yes No Permit $11 - Facility;;egDoce .Soil/GW ContlYes Na <br /> ,mber of Tanks at facility Age of Tanks(if availabla)I TFbrgt Sngl Dual <br /> . TANK 41STORY <br /> as Tank tested? Yes Nm Failed precision test T Yes No If yes, give dace(s) <br /> ias a repair made to the tank system? Yes No —% If yes, what was repaired?I <br /> fas repair done under inspeeti on7 Yes No ere soil samples analyzed? Yes Nol BTXE ITPN-G ITPH•OI Pb/EOBI <br /> type of failure/discharge catastrophic long-term leakage) overfill und:s+own other: <br /> . REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LFAC41MG POTENTIAL ANALYSIS) _ <br /> Soil Sales Received Yes N0 Depth to Ground WaFT <br /> ; Average Annual Precipitation A- 14 10-25 <br /> Cn-Site Wells) Yes No Number i Type Irr <br /> Score S Score S Score <br /> Distance to well($) from Tank ft; ft; 10 pts C 9 ptsC 5 pts <br /> if 0 if 0 if <br /> condition R ConditionR condition <br /> v. Site Feature - Leaching Potential Analysis is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 D 25-i0\1 <br /> Fractures in subsurface (applies to foothills or mountain are �� None UnkrwWn Present <br /> Average Arvwal Precipitation (inches) xxxxxx <10 9 10.25 xxxxaxx 26-40\2 <br /> Man-Made conduits which increase vertical migration Present <br /> of leachate (i.e., septic systema, water wells, ponds) None U ^0on <br /> Unique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> xxxxxx Some one one <br /> COLUIN TOTALS>»TOTAL POINTS I �;' ` a `-L) / <br /> Sample Result: (8 T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> B T X E 8 T X E <br /> NAXIM ALLOUAALE B-T-X-E LEVELS (PPM) 1 50 50 SO .3 .3 1. 1. <br /> LF, <br /> Sale Result: _ (� GASOLINE 1000 100 <br /> Dp;i1 1 l MAXIMUM ALLOWABLE TPH LEVELS (DPM) <br /> L,fp DIESEL 10,000 1000 100 <br /> FOOTNOTES: "`If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (f.e., site is currently on UGT Contamination list for soil or ground water.) <br /> \1 If depth is > 5 ft. and 4 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 3TX3E are not applicable at a TPN concentration of 10 ppm (gasoLim) or 100 ppm (diesoL). <br /> VI. STAFF RECOWENDAT ION/CONCLUSION <br /> 1. Are 3TX b E or TPN Concentrations > Allowable Levels `Yea No <br /> 2. Recommend Site Closure Yes No `If Yes, Refer to site Mitigation for Evaluation <br /> Vl'. REVIEW EVALUATION - TO 3E COMPLETED ST A SUP£RVISCR/SENIOR <br /> CCNCJR WITH STAFF RECCMMENDATION FOR CLOSURE TES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> CATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> E`rALUATCR <br /> EN 23 30 (UGTWKSHT)\5190 <br />