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SAN JOAQUIN COUNTY P1 HEALTH SERVICES/ENVIRONMENTAL HEALTH DI` )N <br /> UGST Wl.nn>HEET FCR SITE CLOSURE EVALUATION ATE <br /> "E OF FACILITY /� l3M.c�� J �. EEPS CODE <br /> DRESS C , N (_ z7q ANK 10 p <br /> NK SIZE UEL TYPE <br /> GENERAL SITE HISTORY <br /> permit current? es 0 ermit d acility StatCode oe.SoiI/GW Cont es No <br /> tuber of Tanks at facility ge of Tanks(if available) ype of Tank teal Fbrgl ngl Dual <br />. <br /> TANK 4ISTORY <br /> ns Tank tested? yes 0 ailed precision test ? as o If yes, give date(s) <br /> as a repair made to the tank system? es No f yes, what was repaired7 <br /> ns repaiM <br /> inspection7 es o dere soil samples analyzed? es No TXE PH•G PH•D b/EDC , <br /> ype of frge atastrophic longterm leakage verfill I sown Cher: <br /> REMOVALACH INSPECTION REPORT FOR SITE OETAILS/COLLECT ,DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Sampes o epth to Ground Water of/Year verage Annual Precipitation = 4 10.25 <br /> n•Sire Wo umber 3 Type Irr I bom I b <br /> S Score S Score S Score <br /> istance to uell(s) from Tank ft; ft; ft 0 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> 3 mditicn R condition R ondition <br />�. Site Feature - leaching Potential Analysis E 's met E is met E is met <br /> linimum Depth to groundwater from the Soil Sample (feet) >100 47 51-100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) xxxx <10 9 10.25 xxxxxx 26.40\2 <br />�nn•Made cordWits which increase vertical migration <br />)f leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br />)nipue site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> zxxx None 9 one / one <br /> COLUMN <br /> COLUMN TOTALS>>>TOTAL POINTS k C7 • �C� _ .. 1�7 <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more,' 41 4a,4s I 40 pts or less <br /> T , <br /> 3,c; pp,,,.. B 1 T X E S "T X E <br /> MAXIML14 ALLOWABLE B-T•X•E LEVELS (PPM) 1 50 SO 50 .3 .3 1. 1. NA\3 <br /> Sample Result: SOL(NE 1000 100 10 <br /> ;i>2 1=10 A%SIUM ALLOWABLE TPH LE`/ELS (PPM) <br /> L TPN IESEL 10,000 1000 100 <br />�COTNOTES: "'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 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 BTXBE are not applicable at a TPH concentration of 10 ppn (gasoline) or 100 ppm (diesel). <br /> STAFF RECOMMENDATION/CONCLUSION <br /> GLS d/ oC� n�/GLc�QL <br /> 1. Are 3TX d E or iPX Concentrations > Allowable Levels Yes L,-�To u , <br /> �,rlh� 2 f�J nl5ISS <br /> 2. Recommend Site Closure es 0 - If Yes, Refer to Site Mitigation for Evaluation <br /> I. REVIEW EVALUATION • TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERREO TO S[TE MI TI WTICRN FOR EVALUATION �ES 10 <br /> aiE REFER REC i, yarn CLOSURE LETTER MAILED <br /> LL <br /> f';A WAt Sf. <br /> H 23 -- '-- <br />