Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HA DIVISIONn Z <br />I• UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE �Z.3l u <br />AME OF FACILITY /1 F1 �fr"O_�LS 1 �ol 1 /365 <br />LtJ WEEPS CODE <br />""'SS 6 iLo C( lIT <br />ANK ID # 3�-f3G3_U� <br />ANK SIZEt0pC>UEL TYPE �CtSo(lw.¢ <br />11. GENERAL SITE HISTORY <br />Permit current? es rmit # acility Status Code �j ( oc.Soil/Gw Cont <br />o es o <br />Aber of Tanks at facility Be of Tanks(if available) 12 type of Tank Leel 11!7rgl ngl DUaL <br />Itl, TANK HISTORY <br />as Tank tested? <br />es <br />o <br />ailed precision test ? <br />as <br />of/Year <br />o <br />f yes, give date(s) <br />= <br />as a repair made to the tank system? as No f yes, what was repaired? <br />as repair done under inspection? <br />es qo <br />ere soil samples analyzed? <br />es <br />o <br />T%E <br />H -G <br />H-Db/EDD <br />Irr <br />ype of failure/discharge <br />om <br />atastrophic <br />tong -term leakage <br />S <br />C <br />0 <br />R <br />E <br />verfill <br />S <br />C <br />0 <br />R <br />E <br />nknown <br />dr: <br />IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALY6ts) <br />Foil Samples Receivedes <br />'ES <br />o <br />epth to Ground water <br />1 4ci, <br />of/Year <br />I 5-fo <br />verage Annual Precipitation <br />= <br />4 <br />10-25 <br />n -Site Wells) <br />es <br />o <br />umber 8 Type <br />I <br />Irr <br />om <br />ub <br />S <br />C <br />0 <br />R <br />E <br />core <br />0 pts <br />1f <br />ondition <br />is met <br />S <br />C <br />0 <br />R <br />E <br />Score <br />9 pts <br />if <br />condition <br />is met <br />5 <br />C <br />0 <br />R <br />E <br />core <br />pts <br />'f <br />ondi tion <br />'s met <br />istance to Wells) from Tank <br />ft; it; it <br />Site Feature - Leaching Potential Analysis <br />inimum Depth to groundwater from the Soil Sample (feet) �p_(fe Z <br />>100 <br />1-100 <br />25-50\1 <br />ractures in subsurface (applies to foothills or mountain areas) <br />None <br />y' <br />Unknown <br />resent <br />verage Annual Precipitation (inches) <br />KXXXXX <br /><10 <br />9 <br />10.25 <br />xxxxxx <br />26-40\2 <br />nn -Made conduits which increase vertical migration <br />f leachate (i.e., septic systems, water wells, ponds) <br />None <br />Unknown <br />resent <br />Inique site features: Recharge area, coarse soil, nearby wells. <br />xxxxx <br />None <br />At least <br />one <br />ore than <br />one <br />COLUMN TOTALS>>>TOTAL POINTS <br />+ <br />CCD <br />J <br />ample Result: (8 T X OR E)rrm <br />E . 12pfM 7 . ogpf'm <br />J( f�''A '6 NDO.t15 <br />.SW P <br />RANGE OF TOTAL POINTS <br />9 pts or more <br />41 48 pts <br />40 pts or less <br />MAXIMUM ALLOWABLE 8-T•X•E LEVELS (PPM) <br />B <br />1 <br />T <br />50 <br />X <br />50 <br />E <br />50 <br />8 <br />.3 <br />T <br />.3 <br />X <br />1. <br />E <br />1• <br />NA\3 <br />'ample Result:ASOLINE <br />N p TPH <br />AXIMUM ALLOWABLE TPN LEVELS (PPM) <br />IESEL <br />1000 <br />100 <br />10 <br />10,000 <br />1000 <br />100 <br />-•^- •-• 11 w�lnucln cu su" am/or grouno 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 TPN concentration of 10 'PIP -(gasoline) or 100 ppm (diesel). <br />VI. STAFF RECOMMENDATION/CONCLUSION <br />1. Are BTX 8 E or TPH Concentrations > Allowable Levels Yes o <br />I2. Recommend Site Closure Yes I No I If Yes, Refer to Site Mitigation for Evaluation <br />VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br />CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE <br />'ES <br />0 <br />EFERRED TO SITE MITIGATION FOR EVALUATION <br />ES <br />0 <br />ATE REFERRED <br />/ / <br />ATE CLOSURE LETTER MAILED <br />AME OF <br />VALUATOR <br />cn " OU %VU1M6J1111\>/YV <br />EH 29 80 <br />