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SAN JOAQUIN CCUNELIC HEALTH SERVICES/ENVIRCHME4TAL HEALTH ION <br /> I, UGS 4RXSHEET FOR SITE CLOSURE EVALUATION ATE C/, <br /> 93 <br /> M1ME OF FACILITY f' axle ��& & 15WE EPS CODE <br /> OORESS l9 E Ao�iC�/6!� X W41Z;m ANK 10-4! p/• <br /> IANK S12E ��d UEL TYPE <br /> I1. GENERAL SITE HISTORY <br /> Is permit current? es o ermi[ # - acility Sta[us Code 35KW <br /> Cont es o <br /> under of Tanks at facility / 9e of Tanks(i( available) ype of Tank teel Fbrgl NL Dual <br /> 111. TANK HISTORY <br /> as Tank tested? If as o ailed precision test 7 es o If yes, give date(s) <br /> as a repair made to the tank system? 1Yes No f yes, what was repaired7 <br /> 'as repair done under Inspectionl If <br /> es o ere soil samples analyzed? es a TXE PH-G PH-D b/E08 <br /> II ype of failure/discharge Itatastrophic long-term leakage ver f ill 1 1106own cher: <br /> iV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es o ep th to Ground Vater �( e(/Tear g/p verage Annual Precipitation = 4 0-25 <br /> -Site Well(s) es I W umber 3 Type Irr an ub <br /> S core S Score S 3core <br /> istance to Wells) from Tank ft; ft; ft C 10 Pts C 9 pts C 5 Pts <br /> 0 if 0 if 0 .f <br /> R cndition R condItion R ordi tion <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> linimum Depth to grourdwater from the Soil Sample (feet) 35-1 b.5'741 <br /> >100 1-100 25-50\1 <br /> tractures in subsurface (applies to foothills or mountain areas) D Nine Unknown resent <br /> Avcrage Annual Precipitation (inches) xxxx <10 9 10-25 KXXXxxx 26.40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) More Unknown resent <br /> nitue site features: Recharge area, coarse soit, nearby wells. At least lore than <br /> 9xxxx None 9 one one <br /> COLUMN TOTALS>>>TOTAL POINTS 2 O * P ' <br /> ample Result: IS T X OR E)/ RANGE OF TOTAL POINTS 9 pts or more 41 - 48 PCs 40 PCs or less <br /> �( �$ B T X E 3T X E <br /> (` NAXIMLM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result ASOLINE 1000 100 10 <br /> AX IFUN ALLOUABLE TPH LEVELS (PPM) <br /> TPN IESEI 10,000 1000 100 <br /> FOOTNOTES: "'If documented soil and/or ground water contamination is present, do not complete the leaching pot entiaL <br /> analysis. (i.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 BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> .. STAFF RECCMENDAT ION/CCNCLUS ICA <br /> 1. Are BTX 3. E or TPH Concentrations >,.-Allowable Levels Ye o <br /> 2. Recommend Site Closure es !f Yes, Refe Site Hi ligation for Evaluation <br /> 'I. REVIEW EVALUATION - TO BE CCMPLE BY A SUPERVISOR/SE4IOR <br /> -ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE IES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> )ATE REFERRED / / ATE CLOSURE LETTER NAILED <br /> LAME Of ,/,/-.// -n <br /> :VALUATOR 14 s-,C — AVL <br /> EH 23 80 (UGTWKSHT)\5/90 /?j L y( 3 <br />