Laserfiche WebLink
SAN JOAOU IN WT WORKSHEETHEALTH <br /> FOR SITESERVICES/ENVIRONMENTAL <br /> EVALUATIONHE�DIVISION <br /> DATE �- <br /> [. <br /> SWEEPS CODE ,I � <br /> Milk <br /> 015 , q <br /> C � TANK ID # �( ' <br /> y E!, <br /> � <br /> TYPE �.o--u <br /> I1. GENERAL SITE HISTORY *** <br /> Is permit current? Yes No Permit # <br /> Facility Status Code Doc.Soil/ Cont Yes No <br /> Number of Tanks at facility <br /> Age of Tanks(if available) Type of Tank Steel Fbrgl Sngl Dual <br /> Ill. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test ? Yes No If yes, give date(s) <br /> Was a repair made to the tank system? Yes No if yes, what was repaired? <br /> Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE TPH-G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic Long-term leakage overfill uknownl lother; <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> t� Average Annual Precipitation A= 14 10-25 <br /> Soil Samples Received Yes No Depth to Ground Water � Ref/Year �YlYCU <br /> On-Site Wells) Yes No Number & Type Irr Dom Pub <br /> S Score S Score S Score <br /> ft; ft; ft C 10 pts C 9 pts C 5fpts <br /> Distance to Well(s) from Tank 0 if 0 if 0 <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis <br /> E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet)_30'—F5- <br /> ! >100 51-100 S 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) <br /> None Unknown Present <br /> Average Annual Precipitation (inches) <br /> xxxxxx <10 9 10-25 xxxxxxx 26.40\2 <br /> Man-Made conduits which increase vertical migration None Unknown Present <br /> of leachate (i.e., septic systems, water wells, ponds) <br /> At Least More than <br /> Unique site features: Recharge area, coarse soil, nearby wells. xxxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS 0 + W <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> B T X E B T X E <br /> N� MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 5 .3 .3 <br /> Sample Result: <br /> GASOLINE 1000 100 10 <br /> MAXIMUM ALLOWABLE TPH LEVELS (PPM) 100 <br /> �, TPH 6 <br /> DIESEL 10,000 1000 � <br /> � tent mal <br /> FOOTNOTES: ***If docuneeied'Soi(land/°site isdwater currentlyon UGTtion is prConteminat iontList for soill oregrourdewater9)� <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 BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels *Yes No <br /> t'a� = 1 90 P/°P <br /> 2. Recommend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluatio z✓t = <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/ <br /> 40 ✓ /�'j/ <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO7LETTERNAILED <br /> TO SITE MITIGATION FOR E YES _NO <br /> DATE REFERRED / / 1 DATE CLOSU <br /> NAME OF <br /> EVALUATOR <br /> ER 23 23 80 (UGTWKSHT)\5/90 <br />