Laserfiche WebLink
SAN JOAOU(N CCT,, i'i f` C HEALTH,: <br /> EALTH SERVICES/EHVIROHNEYtAL HEA iI�' `1H <br />�— f3 UCSF S 'HEEF FOR 'SI TE CLOSURE EVALUATIC . ATE <br /> ntrE of FA[lllTY EEPS'CODE <br /> ODRES5 dLa, P ANK ID"x 11347 <br /> WX SIZE G UEL TYRE IST <br /> GENERAL SITE HISTORY <br /> s permit current? es a ermit - i acility Status Code oe.SoFl/(;W Cant es o - <br />_n+Z+r of tanks at facility ge of Tanks(if available) ype of Sank tecl - Fhrgt ngl EFT <br /> TANK HISTCRY i <br /> is Tank tested?' IF <br /> ailed precision test 1 es a If yes, give date(s). <br /> is a repair made to the tank system? es No f yes,17what was ,repaired? <br /> r <br /> is repair done under inspection? es Tlong-term <br /> ere soil samples analyzed7 es a TXE PH CFTl <br /> PH <br /> 0 b/EDB <br /> Pe of failure/discharge atastrophie teakage verfi'!l nknown ther.- <br /> REPOVAL HISTCRY, (ATTACH INSPECTION REPORTI�FOR S17E DETAILS/COLLECT DATA FOR LEACHt.NG POTENTIAL ANALYSIS) <br /> Fit Samples Rece.1ved es v epth to Ground Slater Zj of/Year 9 verage Ar uat Precipitation k= 4 0-25 i . <br /> i Site 'rell(s) "es a exnt�er a Type (rr cm ub <br /> S core S core S core <br /> stance to Stell{s) from Tank ft; ft; ft C, 0 pts C pts C pts <br /> 0 if 0 if 0 f <br /> onditIon R condition R ondition <br /> Site Feature = Leaching Potential Analys'lis E Is met E is met E s met ' <br /> nimu:rOepth .ta groundwater from the Soil Sample (feet) ,' >100 1-TCO Q 25-50\1 tj+, <br /> y <br /> actures in subsurface (applies to foothills or mountain areas) NoneUnknown 5resent - <br /> crape Annual Precipitation (inches) kxxxxx <10 9 - 10-25 xxxxxxx 26-40\2 <br /> n-Rade conduits which increase vertical migration <br /> leachate {i.e. septic systems, water welts, ponds) None Unknown resent <br /> iGue site features: Recharge area, coarse soil, nearby welts. At least jore than <br /> .{ xxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS + <br /> rpte Result: (B'i X OR E) RANGE OF TOTAL POINTS .9 pts or more 41 -148 pts 40 pts or''less <br /> A,D r <br /> F3 i X E 8 T ! X E ; <br /> MAXIHLH ALLOWABLE B-T-X-E LEVELS (PPH) 1 "50 50 50 .3 .3 li 1. 1. NA\3 <br /> rple Result: i; i ASOLINE 1000 100 10 <br /> AXTMUH ALLOWABLE!',TPH LEVELS (PPH)' <br /> TPH IESEL 10,000 1000 100 , <br />)[NOTES- •'*If documented sail and/or ground water caitamiratlan IS present, da not complete the leaching potential L, - <br /> analysis. (i.e., site Is currently on UCT Contamination List for soit,Lor ground water.) <br /> \1 If depth Is > 5 ft. end < 25 ft., score O�points, l"f depth <=5 ft., do not use table. <br /> \'2 If precipitation is > 40;inches, score 0 points. <br /> \3 Levels for BTX3E are not,liapplicable at a 1`PH concentration of 10 "ppm (gasoline) or 100 ppn (diesel). <br /> STAFF RECCMENDATION/CGICLUSION ! <br /> pA <br /> Are BTX & E or"TPI1 Concentrations > Atlouable LevelsTes o �5 a f+'o Se <br /> 1(Ger <br /> left <br /> Rec-mn-rd Site Closure es o if Yes, Refer to Site Mitigation for Evaluation 44< o44� -�-4 yre oI <br /> REViEW EVALUATIC+I - TO SE COMPLETED BY A SUPERVISOR/SENIOR Oct s <br /> :s <br /> HOUR WITH STAFF RECCHMENOAFION FOR [LOSURE,i6 ES 10 EFERRED TO SITE MITIGATiON FOR EVALUATION ESI 0 <br /> TE REFERRED / / ATE CLOSURE LETTER MAILED- <br /> CF AV <br /> nIJAFCQ �:F.� IA, <br /> 23 80 (UGFVt'SH1)\5/40 <br /> 4 <br /> M is <br />