REMOVAL_REMOVAL 1987 - Laserfiche WebLink

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SAN JOAQUIN COU PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH VISION 1. RKSHEET FOR SITE CLOSURE EVALUATION DATE /! NAME OF FACILITY K �/ / < SWEEPS CODE ADDRESS TANK ID it 13 p 'I — a TANK SIZE FUEL TYPE !V � 11'b.,, D • - 11. GENERAL SITE HISTORY - � Is permit current? Yes No Permit R - Facility Status Code DOc.Soi L/GW Cont Yes No Nuober of Tanks at facility ' Age of Tanks(if available) Type of Tank Steel Fbrgl SngL Dual 111. TANK HISTORY Was Tank tested? Yes No Ix Failed precision test 7 Yes No If yes, give date(s) Was a repair made to the tank system? Yes No If yes, what was repaired? Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE TPH-G TPH-D Pb/EDB Type of failure/discharge catastrophic Long-term leakage overfill unknown other: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) Soil Samples Received Yesix No Depth to Ground Water S'6 I Ref/Year 31" Average Annual Precipitation A=114 10-25 On-Site WeLI(s) �mi Yes No Nber 8 Type Irr Dom Pub S Score S Score S Score Distance to WeLL(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts 0 if 0 if 0 if R condition R condition R condition V. Site Feature - Leaching Potential Analysis E is met E is met E is met Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 Fractures in subsurface (applies to foothills or mountain areas) 0 None Unknown Present Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 Man-Made conduits which increase vertical migration of leachate (i.e., septic systems, water wells, ponds) None Unknown Present Unique site features: Recharge area, coarse soil, nearby wells. At least More than xxxxxx None one �'7Me COLUMN TOTALS>>>TOTAL POINTS ID + + to = 3 1} Sample Result:d(8 T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less � V •01PP B TX E B 1 T X E MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 1 .3 1. 1. NA\3 Sade Result 6�p,/°� GASOLINE 1000 100 10 / Y MAXIMUM ALLOWABLE TPH LEVELS (PPM) V N 1� y>1 DIESEL 10,000 1000 100 FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potential analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) \1 if depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. \2 If precipitation is > 40 inches, score 0 points. \3 Levels for BTX8E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). V1. STAFF RECOMMENDATION/CONCLUSION Ztya-e,Lk 62- 1. Are BTX 8 E or TPN Concentrations > Allowable Levels *Yes No / lG} ✓G�d�¢ i7 L �`/6/ � 2. Recommend Site Closure Yes No X *If Yes, Refer to Site Mitigation for Evaluation 7 `fL`v VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES 0 DATE REFERRED -3 / — 7 Z_ DATE CLOSURE LETTER MAILED NAME OF EVALUATOR EH 23 80 (UGTWKSHT)\5/90