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SAN JOAWIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAff, DIVISION <br /> 11GSY wouKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> 1. <br /> r/ _/ /jH WEEPS CODE / <br /> AME OF FACILITY D,ef J�l O YI1 <br /> /� �v) r� Q�� 11111:11111: ID Y <br /> DRESS 0/ / E i i N�/` <br /> TANK SIZE UEL TYPE <br /> •a <br /> 11. GENERAL SITE HISTORYoc.Soi l/G4 Cont ea ° <br /> Is permit current? ea o ermit Y <br /> ac ty Status Code <br /> udxr of Tanks at facility <br /> ge of Tanks(if available) vA/K Type of laNe tact129 FbrpltvJl Dual <br /> 111. TANK HISTORY <br /> as / <br /> t <br /> o ailed precision tea[ 7 ec o If yea, give date(s) <br /> Tank tea ed? ec / <br /> as a repair [rode to the targe aYatem7 ec No f yes, what was repaired?as IPx-G PM-D b/EDB <br /> °s repair done tsxkF Inspec[Im7 ns ° <br /> CFO soil eenples anal Y+ ? es o <br /> Type of failure/discnorge .ntas[roph lc long-term leakage Ivert ill <br /> r[wn the r: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Satples Received es o ep[h to Ground Water � of/Year <br /> 8 6 verage Atnual Precipitation 4 0.25 <br /> utter L TYPn Irr to ub core <br /> -site ucl l(s) es o S core S core S <br /> ft; <br /> ft C 10 pts C pts L- pts <br /> is[ome to Yell(s) from Tank ft; 0 if 0 if O if <br /> a -unditlon R ordition w ordltlon <br /> -`— 's nxet <br /> E is nM`[ E is nKc E <br /> Site Feature - Leaching Potential Am lysis — 1_100 25.5011 <br /> minus Depth to groundwate a oil Sample (feet) <br /> 100 <br /> Factures In suWurface (applies to foothills or mountain areas) �(9 <br /> None Unknown resent <br /> xxxxx <10 9 10-25 xxxxxx 26-4012 <br /> verage Annual Precipitation (inches) <br /> an-Made coMAlits Which increase vertical migrationresent <br /> I leachate (f.e., septic systetas, water wells, ponds) j o None Unknow[ <br /> At leas[ ore than <br /> ique site features: Recharge area, coarse soil, nearby wells. xx%x None °OC One <br /> COLUMN 701AL5»>TOTAL POINTS <br /> angle Result: (B i % ON E) RANGE OF TOTAL POINTS A pts or more 41 - 48 pts 40 pis or less <br /> ��/_ B r K E B T E <br /> TC/ MAXIMUM ALl0uA0LE 8,T-%•E LEVELS (PPM) 1 50 50 S1O .S .3 — . 1• NAL <br /> 'ASULINE 1000 100 10 <br /> arple Result: <br /> A%)MUM ALLOWABLE TPM LEVELS (PFR) IESEL 10,000 1000 100 <br /> TPH <br /> rp tete the leaching potential <br /> OOINOIES: ...it documented soil and/or ground water coa <br /> ntnlna[fon is present, do not ca <br /> analysis. (i.e., site Is currently on UGI Contanitnt<on fist for boil. <br /> orgrod water.) <br /> ]1 If depth is > 5 f[. aril < 25 f[•. score 0 points. If depth <br /> 1 If prec f pi tat inn is > 40 imhes, score 0 points. <br /> L Levels for BT%LE ore <br /> it Applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX L E or TPM CaN:entrati ons > Allowable levels Ye ° <br /> 2. Recannend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR 411N STAFF RECOMMENDATION FON CLOSl7RE ES O EFENRED 10 SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / a E CLOSURE LETTER MAILED <br /> AME Of <br /> J <br /> .VALUATAf OR <br /> IN 23 HO (UGI4KSH1)\5/90 <br />