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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> i, UST "KSHEET FOR SITE CLOSURE EVALUATION ATE YS <br /> E <br /> FACILITY 8/7.0 "HK ECORD ID 3 ANK ID 4 E Qd L TYPE (,JQ 4 <br /> [I. GENERAL SITE HISTORY <br /> Is permit current? es o ermit N - acility Status Code oc.Soi l/GW Coni es a <br /> umber of Tanks at facility ge of Tank(if available) ype of Tank IS teem FbrgL ngt I Dual <br /> 111. TANK HISTORY <br /> as Tank Tao o ailed precision test ? es o If yes, give date(s) <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> Pas repair done under inspection? �es o ere soil samples analyzed? es o TXE I PH-G I PH-0 I b/EDG <br /> ype of failure/discharge atastrophie long-term leakage I loverfilt noun they. <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 ��p verage Annual Precipitation k= IT <br /> 4 0-25 <br /> -Site Wet l(s) es o umber 8 Type Irr on ub <br /> S core S core S Score <br /> istance to Wells) from Tank ft; ft; ft C 0 pts C pts C 5 pts <br /> 0 f 0 if 0 if <br /> R andition R ondition R ondition <br /> Site Feature - Leaching Potential Analysis E s met is met E is met <br /> inimDepth to groundwater from the Soil -�Sample (feet) y, 5 >100 1-100 �� 25-SOL <br /> an <br /> Fractures in subsurface (applies to foothills or mountain areas) 10 None I Unknown resent <br /> verage Annual Precipitation (inches) xxx 00 9 10-25 xxxx 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, or wells- At Least ore :hon <br /> (Mmncipal=>2000 ft; damestie»500 ft; irr/agricultural=present] xxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS <br /> ample Result: (G T % OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less \ <br /> B 7 % E 3 <br /> MAXIML24 ALLOWABLE G-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1- 1. NA13 <br /> ample Result: "LINE 1000 100 - 10 I <br /> A%IMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESEL 10,000 1000 100 <br /> FOOTNOTES; --If documented soil and/or grand water contamination is Present, do not complete the Leaching potential <br /> arslysis- (i.e., site is currently on UGT Contamination List for soil. or grovel water.) <br /> L If depth is > 5 ft- and < 25 ft-, score 0 points- If depth c5 ft., do not use table- <br /> 12 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTXEE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (dienet). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX 8 E or TPH Concentrations > ALloweble Levels es o <br /> ?. Recommend Site Closure ss o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/LEAD SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES O EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER NAILED <br /> AME OF <br /> VALUATOR <br /> EH 23 do (UGTWKSHT)\5/94 <br />