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V ,4 <br /> DATE <br /> SAN JOAQUIN COURT' ON <br /> SHEETA FOR sm. CLOSUREI EVALUAT <br /> UGST AL HEALTH Dl "y <br /> CC SWEEPS CODE <br /> OF FACILITY OL TANK 10 <br /> ESS <br /> SIZEFUEL TYPE LL +++ <br /> �L''a <br /> Doc.Soil/GW Cont Yes <br /> NERAL SITE HISTORY Facility Status Code No <br /> No permit # Type of Tank Steel <br /> Fbrgl Sngl Dual <br /> ,,,it current? Yes �• K T <br /> Age of Tanks(if available) <br /> er of Tanks at facility I <br /> ANK HISTORY No If yes, give date(s) <br /> / / <br /> Tank tested? Yes No Failed precision test ? Yes <br /> If Y No <br /> es, whet was repaired7 <br /> a repair made to the tank system? es No Were soil soap <br /> les analyzed? Yes No BTXE TPH-G TPH•D Pb/EDB <br /> repair done under inspection? Yes other: <br /> of failure/discharge catastrophic long-term Leakage <br /> overfill unknown <br /> 0 �/ o b <br /> MOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE ID Average Annual Precipitation A= 14 10-25 <br /> teA1LS(CRef/Year OLLECT DATA FOR LEACHING POTENTIAL ANALYSIS <br /> Samples Received Yes No Depth to Ground Score <br /> Dom pub S Score S <br /> Nurber & Type irr S Score C 9 pts 0 i pts <br /> ite Wells) Yes No 0 10 pts p if <br /> ft; ��ft 0 if 0 if R is met from Tank ft. condition R condition is met <br /> ante to Well(s) R E is met E <br /> E is mac <br /> Site feature - leaching Potential Analysis 6i6,. >100 <br /> 51-100 25-50\1 <br /> 1I Unknown Present <br /> mum Depth to groundwater from the Soil Sample (feet) None 1 <br /> tures in subsurface (applies to foothills or mountajn areas xx <10 <br /> q 10.25 xuxxxx 26-40\2 <br /> xxxx <br /> age Annual Precipjtatjon (inches) � Unknown present <br /> None <br /> Made conduits which increase vertical wmigrati>0^ds ) At least More than <br /> eachate (i.e., septic systems, r7 one <br /> wells. � one <br /> xxXXXX None = I <br /> �e site features: Recharge area, coarse soil, near y -36 + 5 <br /> 41 - 4a Pts 40 Pis or less <br /> COLUMN TOTALS»>TOTAL POINTS <br /> RANGE OF TOTAL POINTS 49 pts or more <br /> T X E a T X E NA\3 <br /> e Respuplt: (/a PP5 PO ti 8 1 50 50 50 .3 .3 1. 1• <br /> ` rpf <br /> v S!P" � MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 100 10 <br /> pO$PP� GASOLINE 1000 <br /> too <br /> e Result: MA)(I NUN ALLOWABLE TPH LEVELS (PPM) DIESEL 10,000 <br /> loco <br /> / fete the Leaching potential <br /> 7 Ap�TPH-lam resent, do ^°t compgroundlete water.) <br /> **elf documented soil and/or groom water contamination is P <br /> )TES: on UGT Contaminat<=5 ft t dornot�use table. <br /> analysis. (i.e., <125 ft., scorcurr e 0 points. If depth (diesel). <br /> \1 If depth is > 5 ft. 1 3 inches, score 0 Points. (gasoline) or 100 ppm <br /> \2 If precipitation is ticabLe at a TPH concentration of 10 ppm J q_D�dw <br /> \3 Levels for BTX&E are not app (�fYQt) 74q0-0 <br /> F RECOMMENDATION/CONCLUSION +Yes No x <br /> re BTX & E or TPH Concentrations > Allowable Levels <br /> econmend Site Closure Yes <br /> No •if Yes, Refer to Site Mitigation for Evaluation <br /> REFERRED To SITE MITIGATION FOR EVALUATION YES NO <br /> JEW EVALUATION - TO BE COMPLETED BY A Sl1PERV150R NO N10 <br /> R WITH STAFF RECOMMENDATION FOR CLOSURE YES <br /> ! / DATE CLOSURE LETTER MAILED <br /> 2EFERREO <br /> 1f ^� <br /> kTOR <br /> So (UGTWKSHT)\5/90 <br />