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SAN JOAQUIN CC PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAWDIVISION / <br /> WORKSHEET FOR SITE CLOSURE EVALUATION DATE <br /> NAME OF FACILITY "[L�, SWEEPS CODE L� <br /> ADDRESS ,� f ,J ,ST 9C-OY�J TANK ID #13al. <br /> TANK SIZE ;N J�� FUEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> is permit current? Yes No I xiPermit # - Facility Status Code Doc.Soil/GW Cont Yes No <br /> Number of Tanks t facility '1 Age of Tanks(if avaiLable) �� Type of Tank teeL Fbrgl Sngl Dual <br /> 1111. TANK HISTORY <br /> Was Tank tested? Yes I \'kN,[X Failed precision test ? Yes No if yes, give/date(s) <br /> Was a repair made to the to system? Yes No If yes, what was repaired? <br /> Was repair done under inspectio Yes No Were soil samples analyzed? Yes No BTXE TPH-G TPH-D Pb/EDB <br /> Type of failure/discharge catast phis Long-term leakage overfill noun other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION R ORT FOR SITE DETAILS/COLLECT DATA FOXLEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth o Ground Water J Ref/Year ; Average ArvwaL Precipitation A= 14 10-25 <br /> On-Site WeLL(S) Yes No Number 8 Type Irr Dom x <br /> Pub <br /> S Score S Score S Score <br /> Distance to Welft; 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 (fee >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain ar rs) 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 <br /> of Leachate (i.e., septic systems, water cells, ponds) None Unknown Present <br /> Unique site features: Recharge area, coarse soil, earby cells. At least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS>>TOTAL PO TS + _ <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 is or more 41 - 48 pts 40 pts or less <br /> 8 X E B T X E <br /> MAXIMUM LLOWABLE B-T-X-E LEVELS (PPM) 1 5 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000. 100 10 <br /> MAXIMUM�TCLOLIABLE TPH LEVELS (PPM) <br /> TPH DIESEL 10,000 \ 1000 100 <br /> FOOTNOTES: ***If documen soil and/or ground water contamination is present,\do not complete the leaching potential <br /> ana ysis. (i.e., site is currently on UGT Contamination Lift 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 /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX 8 E or TPH Concentrations > Allowable Levels *Yes No <br /> 2. Recommend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE REFERRED TO SITE MITIGATION FOR EVALUATION YES II I <br /> NO <br /> YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED / / , <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />