Laserfiche WebLink
SAN JOAQUIN A PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEA�OIVI SION � <br /> I. UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITY C- �. �_. ;-._ - .., n rf: : 1 WEEPS LOGE <br /> DDRESS 71 �b --_ rv',:%,,... -. �• lJ ANK ID p <br /> aNK SIZE UEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> Is permit current? es o er IF acility Status Code oc.Soil/GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) IType of Tank teel Fbrgl ngl I Dual <br /> ill. TANK HISTORY <br /> as Tank tested? es o ailed precision test ? eso If yes, give date(5) <br /> as a repair made to the tank system? as No f yes, what was repaired7 <br /> as repair done under inspection? �e-740 ere soil samples analyzed? es to TXE PH-G PH•0 b/EDO <br /> Type of failure/discharge a[astroph ie longterm leakage verf ill I knknown th er: <br /> IV, REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Samples Received es o epth to Ground Water of/Year verage Annual Precipitation kz 4 10.25 <br /> -Site Well(s) as I o I umber 8 Type Irr pm uu <br /> S core S Score S icore <br /> istance to Wells) from Tank ft; ft; ft C0 pts C pts C pts <br /> 0 if 0 if 0 if <br /> R onditian R ondition R ondition <br /> Site Feature . Leaching Potential Analysis E is met E is met E is met <br /> inimun 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 /> verago Annual Precipitation (inches) xxxxx <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)) <br /> None Unknpwn resent <br /> )nique site features: Recharge area, coarse soil, nearby wells. At least lore than <br /> x/xxx None one 'I on7e <br /> COLUMN TOTALS»>TOTAL POINTS l �/ L� <br /> Simple Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 . 48 pts I 40 pts or less <br /> 6 T X E 8 T X "c <br /> MA%IMLW ALLOWABLE 0-T•%•E LEVELS (?PM) 11 SO 50 50 .3 .3 1• 1. NA\3 <br /> •amp/l/e Result: ASOLINE 1000 100 '0 <br /> -6 A%IMUN ALLOWABLE TPH LEVELS (PPM) <br /> (l IESEL 10,000 1000 100 <br /> FOOTNOTES: *"If documented soil and/or ground water contamination is present, do not complete the leaching potentia( <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 BTXSE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). I ' <br /> V1. STAFF RECOMMENDATION/CONCLUSION 4�s <br /> 1, Are DTX 3 E or TPH Concentrations > Allowable Levels Yes o ,r <br /> 2. Recommend Site Closure 1Yes I o If Yes, Refer to Site Mitigation for Evaluation <br /> `JI I. REVIEW EVALUATION . TO BE COMPLETED BY A SUPERVISOR/SENIOR66 )y\� On'� " <br /> .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 PEFERREO TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF i <br /> .VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> ,1-I 29 30 <br />