Laserfiche WebLink
SAN JOACUIN CQJ*8LIC HEALTH SERVICES/ENVIRONMENTAL HEALTISION <br /> UGS1 WORKSHEET FOR SITE CLOSURE EVALUATION AtE <br /> nHE OF FACILITY / ✓J EPS CODE Z� <br /> OORESS , Q �O,l / /S-i l /. I- /] ANK 10 X I <br /> tAHK SIZE o UEL TYPE vdv� •7 �GLO�I. v <br /> 'I. GENERAL SITE HISTORY 1 <br /> Is permit current7 es o ermit tl - acit ipity Status Co7Tankq <br /> GW Con es o <br /> umber of tanks at facility ge of Tanks((f available) /Lry/ ype ofgl rgl Dual <br /> 11. TANK HISTORY ✓�� <br /> as Tank tested? es o - ailed precision tesc es I o I If yes, give date(s) <br /> as a repair made to the tank system? as No I Of yes, what was repaired? <br /> 'as repair done under inspecticn7 es o ere soil samples analyzed? as o TXE I PH•G I PH•D b/EDB <br /> ype of failure/discharge atastrophic Long-term leakage verfill nknown I lo <br /> cher: <br /> V. REMOVAL HISTORY (ATTACH INSP TION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es o epth to Ground Water rp of/Year :!yr 0 6 verage Arnual Precipitation = 4 0-25 <br /> n-Site WeLt(s) IYes 1 11 <br /> o umber 8 Type lrr I u6 <br /> S score S core S core <br /> istance to Welt(s) from Tank N ft; ft; ft C 0 pts C pts C pts <br /> 0 if 0 1f 0 f <br /> R ordition R ondition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E 'S met <br /> inimtm Depth to groundwater from the Soil SartQle tfeet)(Uv�jai% ', >100 1-100 25-50\1 <br /> ractures in subsurface (applies to foothills or morn tain areas) None Unknown resent <br /> Average Annual Precipitation (inches) KXXxxX <10 9 10-25 Kxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water wells, ponds) Hone Unknown resent <br /> ni tive site features: Recharge area, coarse soil, nearby wells. At least iore than <br /> xxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS r a <br /> Sample Result: IS T X RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> J�2Tr-� B T X E a T % E <br /> D5 HAXIMIAI ALLOWABLE 0-T•%•E LEVELS (PPM) i 50 50 50 .3 .3 1. 1. 4A\3 <br /> ample Result: V.g}C-(• ASOLINE 1000 100 10 <br /> _A ll N -.TPH0)c— <br /> MI AXItUM ALLOWABLE TPH LEVELS (PPM) <br /> H 0)c— IESEL 10,000 1000 100 <br /> COTNOTES: ...If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (i.e., site is currently on LOT Contamination List for soil or grovel water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth 4=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 Fpm (diesel). <br /> 1. STAFF RECCMENDATION/CONCLUSION <br /> 1, Are BTX $ E or TPH Concentrations > At able Levels Yes o <br /> mm <br /> 2. Recoend e es o Site ClosurIV, If Yes, Refer to Site Mitigation for Evaluation q 7' (� <br /> I1. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR J�LI.LV- Y <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 I EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> )ATE REFERRED / ATE CLOSURE LETTER MAILED <br /> JANE OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />