Laserfiche WebLink
SAN JOAOUINONTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION q ? <br /> 1. LOST WORKSHEET FOR SITE CLOSURE EVALUATION ATE 1� [J <br /> AME OF FACILITY JL WEEPS CODE <br /> DDRESS - C) 3 ` 1 ANK ID # <br /> TANK SIZE S50 IFUEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> Is permit current? es o ermit # I IFacility Status Code oc.Scil/Gw Cont 1Yes Jo <br /> umber of Tanks at facility ge of Tani available) ype of Tank teal Fbrgl nil Dual <br /> 111. TANK HISTORY <br /> as Tank tested? es IFailed precision test ? as o If yes, give date(s) <br /> as a repair made to the tank system? es No lif yes, what was repaired? <br /> as repair done under inspection? as q0 ere soil samples analyzed? es !o TXE PH-G PH-D b/EDB <br /> Type of failure/discharge atastrophic long-term leakage verfill nknown 10ther: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ,oil Samples Received as o epth to Ground Water of/Year verage Annual Precipitation = 4 10-25 <br /> On-Site well(s) as o umber 8 Type Irr om ub <br /> S core S Score 5 icore <br /> istance to Wells) from Tank ft; ft; ft C 0 pts C 9 pts C i pts <br /> 0 if 0 if 0 "f <br /> R onditi on R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E 's met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1-100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) KXXXXX <10 9 10-25 xxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown �j resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. At leastCC ore than <br /> xxxxx None one Is one <br /> COLUMN TOTALS»>TOTAL POINTS `D + l + I Q <br /> ample Result: (B T % OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or Less <br /> (AJo�p, o 4 pprA — <br /> �A)Dcc�',o%vP� <br /> 4MAXIMUM ALLOWABLE B-T•%-E LEVELS (PPM) G 50 50 50 .3 .3 1. 1. NA\3 <br /> -ump�e Resulhp*,� rIESEL <br /> SOLINE 1000 100 10 <br /> D, Sfpm I' AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH 10,000 1000 100 <br /> OOTNOTES: ***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 BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION cta--tE -p„� <br /> w��Qat. Are BTX 8 E or TPH Concentrations > Allowable Levels Yes <br /> 2. Recommend Site Closure 1Y <br /> as I o I If Yes, Refer to Site Mitigati am for Evaluation �e ' o-l�'�'s�c <br /> V11, REVIEW EVALUATION . TO BE COMPLETED BY A SUPERVISOR/SENIOR a-'loo-amort C,QbQJL2.Q� <br /> .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 10 EFERRED TO SITE MITIGATION FOR EVALUATIONES JO <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />