Laserfiche WebLink
SAN JOAQUIN C& PLILIC HEALTH SERVICES/ENVIRONMENTAL HE VISION <br /> I. UGST W2KSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITYIIJC�-r N// wo_ EEPS CODE <br /> OORESS �6b0 �, U `� NQyA7 ��`. ANK 10 d <br /> ANK S12E FUEL TYPE / <br /> 11. GENERAL SITE HISTORY <br /> Is permit current? es a ermit At IFacility Status Code o:.Soil/GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) ype of Tank teel Fbrgl ngl Oval <br /> 111, TANK HISTORY <br /> Jas Tank tested7 as o ailed precision test ? es o If yes, give date(s) <br /> Jas a repair made to the tank system? as No f yes, what was repaired? <br /> ns repair done under inspection? es Hol Jere soil samples analyzed? as to TXE PH•G PH-0 b/E00 <br /> Yoe of failure/discharge atastrophic (long-term leakage verf ill nknwn cher: <br /> IV, REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received as o epch to Ground Water of/Year } d verage Annual Precipitation = 4 11 <br /> 0.25 <br /> -Site ueM s) es o umber S Type Irr on uu <br /> 5core 5 core S 3core <br /> istance to Wells) from Tank ft; ft; ft C 0 pts C pts C 5 pts <br /> 0 f 0 if 0 if <br /> - <br /> R onodition R ondi[ion R rdi cion <br /> Site Feature . Leaching Potential Analysis E s met E is met E is met <br /> inimAm Deptn to groundwater from the Soil Sample (feet) >100 1.100 25-50\1 <br /> rapturesin subsurface (applies to foothills or mountain areas) I 0 None Unknown resent <br /> verage Annual Precipitation (inches) ` xxxx <10 xxxAxxx 26-40\2 <br /> nn-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, cords) None Unknown 5 resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. At least lore than <br /> Xxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS <br /> 10 � 0 <br /> 3 3ample Result: (D T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 68 pts 40 pts or less <br /> S T X E B 1 1 X E <br /> MAXIMUM ALLOWABLE 3•T-X-E LEVELS (?PM) 1 ` 50 $0 50 .3 .3 1. 1. NA\3 <br /> 'ample Result: ASOLINE 1000 100 I 'D <br /> AX lMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPN IESEL 10,000 1000 100 <br /> OOTNOTE S: •'•If documented Soil and/or ground water contamination is present, do not complete the leachingZese <br /> tial <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.If precipitation is > b0 incnes, score 0 points. <br /> Levels for BTXEE are rot applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (d . <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1, Are BTX 3 E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION • TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> .CNCUR WITH STAFF RECCMMENDATICN FCR CLOSURE �ES 0 EFERRED TO SETE MITIGATION FOR "EVALUATION ES JO <br /> ATE REFERRED / / �ATEE CLOSURE LETTER MAILED <br /> AME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> �A 29 r0 <br />