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i <br /> SAN JOACLIIN CCU' UBLIC HEALTH SER'!ICES/ENVIRCNMENTAL'�HEALT ISION <br /> UaCRKSHEET FOR SITE CLOSURE EVALUATICN ATE r� <br /> Ar.E OF FACILITY -1 <br /> EEPS CCOE /Jr-a Z <br /> 110DRESS <br /> 3� N, Broct�afl,�rt Aux ID x - /,5.Z <br /> ANK SITE UEi TYPE i <br /> } <br /> it. GENERAL SITE HISTORY �l f <br /> Is permit current? esa ermit - acility Status Code ' oc.Soil/Gk Cant es o <br /> i <br /> umber o{ Tanks at facitity 1r ge of Tanks(if available) ypekaf Tank Leet Fbrgl ryl Dual <br /> Ill. TANK HISTORY �=, Ne.v ,.+k <br /> ns Tank tested? es o aited 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 /> Ep <br /> as repair done under inspection? es o r/ ere snit samples analyzed? es I� o TXE PH-G PH-0 b/E08 <br /> ype of failure/discharge atastrophic tong-term leakage verfill known cher: <br /> s <br /> IV. REMOVAL HISTORY (ATTACK INSPGCTICH REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHI'NC POTENTIAL ANALYSIS) <br /> oil Samples Received es o epth to Graend Slater ,�S of/Tear 5 I,' verag'e Annuat Precipitation = G 0-25 <br /> i it <br /> Ei,ta <br /> EleVet <br /> ) es o ✓ umber & Type Irr orn ub F <br /> S tate S core S carel(s) from Tank _f t; fr; ft C 0 pts. C 9 pts C pts <br /> O if I o if 0 f <br /> R ondition Rarsdition R ordition <br /> Site Feature - Leaching Potential Analysis E is mete E is met E s met <br /> inimum Depth to groundwater from the Soil Sample (fee[) . >100 -ICO 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) 0 gone ! Unknown resent <br /> vcrage Annual Precipitation (inches) Lxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration i p <br /> f leachate (i.e., septic systems, water wells, ponds) None i' Unknown resent . <br /> pique site features: Recharge area, coarse soil, nearby wells. is At leastore than <br /> xxxx IMem �'` one one i <br /> COLUMN TOTALS> >TOTAL POINTS 10 + + 1v <br /> i <br /> ample Result: (8 T X 09 E�p RANGE OF TOTAL POINTS 9 pts or more_: 41 - 48 pts 40 pts or Less <br /> d <br /> 00 16 -r i <br /> B T IX JE 8 T X E <br /> MAXIMI?i ALLOVABLE R-T-X-E LEVELS (PPM) 1 50 50 5( .3 1 .3 1. 1. NA\3 <br /> ample Result: lj.�/ ASCLINE 1000 100 IO <br /> AXI" ALLOWABLE TPH LEVELS (PPM) <br /> TPH—b IESEL 10,000 11000 100 ` <br /> COTHOTES: *"*If documented soil and/or ground water contamination is present, do not .cemplete the Leaching potential ;} <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 /> N2 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 (dieset). <br /> .r <br /> II. STAFF RECCHMENDATION/CCNCLUSION i1r <br /> 1. Are 3TX E or TPH Concentrations > Allowable Levels Tes o <br /> 2. Reconinend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation` i <br /> r} <br /> 11. REVIEW EVALUATION - TO BE CCHPLETED 8Y A SUPEIV1SCR/SENIOR <br /> CONCUR WITH STAFF RECCHMENDATION FOR CLOSURE SES 0 EFERRED TO SITE HITIG'ATICN FOR cVALUATICN ES 0 <br /> ATE REFERRED � / J / (� / ATE CLOSURE LETTER MAILED <br /> 1Ar.5 OF <br /> ;VALUATOR <br /> F <br /> 23 30 (UGTti.•KSHT)\5/90 <br />