Laserfiche WebLink
SAN JOAQUIN COUNTOBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH to;ION <br /> t- UGST WORKSHEET FOR SITE CLOSURE EVALUATION AT <br /> nME OF FACILITY EEPS CODE <br /> DDRESS /s 6 5 I/771A 'J7 ANK 10 q j<) <br /> tANK SIZE UEL TYPE <br /> It. GENERAL SITE HISTORY .. <br /> Is permit cui rent? I I es t o ermit N o p - /50-3 IF acility Status Cade oc.Soil/GW Cant es o <br /> anter of Tanks at facility a ge of Tanks(if available) IType of Tank Leel 1brgl ngl Dual <br /> 'Il. TANK HISTORY <br /> ms Tank tested? es o ailed pIf yes, give <br /> recision [est 7 es o dates) <br /> os a repair made to the tank system? es No f yes, what was repaired? <br /> ms repair done under inspection? as o ere soil samples analyzed? es 11 <br /> TXE I PH-G PH-D b/EDB <br /> Type of failure/discharge atastrophic long-term leakage verfill I nknown cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soft Samples Received Ifes o epth to Ground Water of/Year verage Annual Precipitation N= 11 <br /> 4 11 <br /> 0-25 <br /> Dri-Site Weil(s) es o unbar b Type Irr 0a ub <br /> S core S core S core <br /> istance to Wells) from Tank ft; ft; ft C 0 pts C pts C pts <br /> 0 if 0 if 0 if <br /> R ondition R condition R ordition <br /> J. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimun Depth to groundwater from the Soil Sample (feet) >100 1-100 25.50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage 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) None Unknown resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS + } <br /> anple Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 • 48 pts 40 pts or less <br /> B TX E B T X E <br /> MAXIMLM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> apple Result: <br /> r1ESELj <br /> 1000 100 10 <br /> AXIMIH ALLOWABLE TPH LEVELS (PPM)TPN 10,000 1000 100 <br /> OOTNOTES: •"If docunented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (i.e., site is currently on LOT Contamination List for soft 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 /> VI. STAFF RECOMMENDAT ION/CCNCLUS ION <br /> 1. Are BT% E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Reconmerd Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> V11. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> .OHCUR WITH STAFF RECCMMENDA TION FOR CLOSURE ES 0 I EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> )ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> LAME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 MW <br />