Laserfiche WebLink
/ SAN JOAOUi T PUBLIC HEALTH SERVICES/ENVIRONMENTAL „,. _ IVISIQN <br />,f[ q UGST WORKSHEET FOR SITE, CLOSURE -EVALUATION ATE f� <br /> AME OF FACILITY ����- EPS CODE <br /> RDRESS �UD' AHK ID Al A901 <br /> LANK SIZE fr 900 UEL T/Y`PE7WlJ <br /> [I. GENERAL <br /> SfTE HISTORY <br /> Is permit!'Current? es o ermft it - s acilfty Status Code j oe.Soit/Gw Cont es o <br /> mnber of .Yanks at facility ge of Tank,SOf available) ype of Taikk keet brgl ngl Dual <br /> III. TANK HISTORY <br /> Jas Tank tested? es o ailed precision test:T es a if yes, give date(s) <br /> Jas a repair made to the tank system?', es No f yes, what was repaired? <br /> as repair done under inspection? es 40 ere soil samples anotyxed? eso ry� TXE PH-G PH-0 b/EDB <br /> ype of failure/discharge atastrophic tong-term4leakage verfitl known Ither: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) !' <br /> " <br /> oil Samples Received es a epth to Ground tracer of/Year $3 verage Annual Precipitation <br /> -Site Llett(s) es o umberl8 Type Irr oroub : 7 <br /> S core ; S Score S core f <br /> istance to uetl(s) from Tank Ift; ft;ll r ft C 0 pts C pts" C pts' ' <br /> 0 if 0 if 0 <br /> R OMI tion `.y R ondition Ronditioii <br /> Site Feature - Leaching Potential ;Analysis `�' E s met fE. is met E ` is <br /> met <br /> 11 <br /> inimum Depth to groundwater from the.Solt Sample (feet) >100 1-100 25-50\1° <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent" t <br /> verage Annual Precipitation (inches) KXXXXX <10 ,9 10-25 xxxxxxx 26-40\2, <br /> an-Made conduits which increase vertical migrationil <br /> f leachate (i.e., septic systems, water welts, ponds). None L1 Unknown resent <br /> ique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> xxxxxx Hone one one <br /> " <br /> COLUMN TOTALS>>>TOTAL POINTS �. + + N <br /> s <br /> lNR`7esult�(B T� ODE)�% Q r RANGE OF TOTAL POINTS 9 pts or more 4� 41 - 48 pts 40 pts or less <br /> 'j ,I}U53?Q Ll I �i B T X E B T % E E <br /> MAXIMUM AtLOiJABLE B,-T-XF E LEVELS (PPM) 1 50 50 [50 .3 .3 1. 1. 1 HA\3 <br /> ample Result: E ASOlINE 1000 �f 100 10 <br /> Ax IMUM ALLOWABLE TPH LEVELS: (PPM) I <br /> QQ M TPH—(� j�. i IESEL 10,000 1000 100 <br /> OOINOtES: ***If documented soit''and/or ground water contamination is present, do not complete the leaching potential <br /> gnatysis. (t.e., site is currentty on UGT Contamination List for soil or ground water.) , <br /> \1 if depis > 5 ft and < 25 ft., score 0 paints. If,depth <=5 ft., do'inot use table. " <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> I> \3 Levets for BTX&E are not applicableat a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). W <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX E or TPH Concentrations a'> Altowabte Levels Yesa my i <br /> 2. Recommend Site Closure es o k If Yes, Refer to Site Mitigation for Eva Iuati.on ,-Q,04 k`o\ ` r\ f <br /> VII. REVIEW EVALUATION - TO BE COMPLETED;,BY A SUPERVISOR/SENIOR <br /> i <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> p $ is <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> LAME OFr� ci� r~ <br /> :VALUATOR �n J t �_ ° ,� 4 M 3 <br /> EH 23 80 (U6TLIKSHT)\5/90 <br />