Laserfiche WebLink
SAN JOAQUIN C(� PUBLIC HEALTH SERVICES/ENVIRONMENTAL }'_ DIVISION <br /> 1, WORKSHEET FOR SITE CLOSURE EVALUATION DATE �/+-30 <br /> NAME OF FACILITY �`'+�� / SWEEPS C00 L' <br /> ADDRESS 3J 07 �tz v-e, 'Z.J . J c' l'l .&9-yv TANK ID #132_ n- 2 j� <br /> TANK SIZE FUEL TYPE //�/�1�/'.P//f?�✓GL� reVeabc � J �j� f <br /> 11. GENERAL JI 0 **4� _<._ <br /> Is permit current? Yes No Permit # - Facility Status Code Doc.Soil/GW Cont Yes No <br /> Number of Tanks at facility ` Age of Tanks(if available) / � Type of Tank Steel Fbrgl Sngl Dual <br /> Ill. TANK HISTORY <br /> Was Tank tested? Yes No �( Failed precision test ? Yes No If yes, give date(s) <br /> Was a repair made to the tank `system? Yes No If yes, What Was repaired? <br /> Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE TPH-G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water JL) Ref/Year Average Arcual Precipitation A= 14 10-25 <br /> On-Site Well(s) Yes Na Number & Type Irr Dom x <br /> Pub <br /> S Score S Score S Scare <br /> Distance to WeLI(s) from Tank _ft; - #t9 ,ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet)SO4 >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) / Q None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-Made conduits which increase vertical migration bra 1yo v:+ <br /> of Leachate (i.e., septic systems, water wells, ponds) (xtc(C�trltc� None Unknown u� Present <br /> Unique site features: Recharge area, coarse soil, nearby wells. At Least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS I J = 3 <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or Less <br /> /l ' n ^ B T % E B T X E <br /> H lli D MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample /Resullt:J\ GASOLINE 1000 100 10 <br /> /ltl hill/ TPH MAXIMUM ALLOWABLE TPH LEVELS (PPM) DIESEL 10,000 1000 100 <br /> FOOTNOTES: ***If documented soil and/or ground 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 BTX&E are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION p L, H(O <br /> 1. Are BTX & E or TPN Concentrations > Allowable Levels *Yes No <br /> 2. Recommend Site Closure YesNo If Yes, Refer to Site Mitigation for Evaluation f L '�L�7 <br /> j. 144 D aY7 cN <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> �I -S' <br /> S L O <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED / / <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />