Laserfiche WebLink
SAN JOAQUIN CEIALIC HEALTH SERVICES/ENVIRONMENTAL HEALTH ( ION <br /> 1. LOST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> TAME OF FACILITY / _ EEPS CODE /5U= <br /> DD RE SS <br /> c� / ANK ID It 3<) - /r0.3 — Cl ✓ <br /> /S(�� S- `7f� X17 <br /> [ANK SIZE r �,� r'.( UEL TYPE <br /> II. GENERAL SITE HISTORY <br /> Is permit current? est o ermi! A 0 p - /SUS aeility S[a 1113 Code EE oc oi� Cont es !r o <br /> unber of Tanks at facility D Be of Tanks(if available) 14JL APe of Tank teeL Fbrgl ngl Dual <br /> 111. TANK HISTORY <br /> Ins Tank tested? as ✓ o ailed precision test 7 es o If yes, give date(s) <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> ns repair done under inspection7 as o ere soil samples analyzed? as ✓ o TXE PH-G PH-O b/EDS <br /> Type of failure/discharge atastrophic long-term leakage verfill known + cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es /o epth to Ground Water /ri of/Year �Y;, G1-ragenual Precipitation = 4 0-25 <br /> •Site WeLL(s) es o umber 8 Type irr ubS corcore S core <br /> istance to WeLL(s) from Tank ft; ft; ft C 0 ppts C Pts <br /> 0 if1f 0 1f <br /> R ondondition R ondi tion <br /> V. Site Feature - Leaching Potential Analysis E is mis met E is met <br /> iniRxm Depth to groundwater from the' it Sade (feet) 1101-100 25.50\1 <br /> Fractures in subsurface (applies to foothills mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) x <1 9 1 25 xxxxxx 26.40\2 <br /> an-made conduits which increase vertical migration <br /> F leachate (i.e., septic systems, water welts, ponds) N e Unknown resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> xxxx one one <br /> COLUMN TOTALS»>TOTAL POINTS I t t <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or mo a 41 - 48 pts 40 pts or less <br /> B T X B T X E <br /> MAXIMLH ALLOWABLE B-T-X-E LEVEL (PPM 1 50 50 0 .3 .3 1. 1. 4A\3 <br /> an9l e.R€suit: ASOLIHE 1000 100 10 <br /> AXIMUN ALLOWABLE TPH LEVELS (PPM <br /> TPH IE SEL 10,000 1000 100 <br /> WTHOTES: f documented soil and/or ground water contamination is present, o not complete the leaching potential <br /> analysis. (i.e., site is currently on UGT Contamination Li t for soil or grovel water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 , 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 /> /I. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX $ E or TPN Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure es o tz If Yes, Refer to Site Mitigation for Evaluation <br /> V11. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> -ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERREO TO SITE MITIGATICN FOR EVALUATION ES 0 <br /> )ATE REFERRED //�) /� / ATE CLOSURE LETTER NAILED <br /> nM' OF Q� <br /> L4 23 30 (UGTWKSHT)\5/90 <br />