Laserfiche WebLink
SAN JOAQUIN CR i '.IC HEALTH SER'/ICES/EHVIRCHNE4TAL,HEAI rT CH <br /> UGST SHEET FCR SITE CLOSG'RE EVALUATICN —Ar E <br /> anr.E OF F1CIL[TT UFEPS CCOE 7 <br /> BiZ !DE1�S�N E i Fl,QE57al1 a75�l(o <br /> nORESS Tb� TANK io s - � ► ! <br /> a,uuK SIZE UEL TYPE <br /> i <br /> GE4fRAl SITE HISTORY is <br /> is permit current7 es o ermit !•I - acility Status Code oc.Sai[/Gu Cont es o . <br />'rant r of Tanks at facility Age of Tanks(if available) ype of tank : teel Fbrgl ngl ' Dual <br /> r. TANK HISTCA 0 <br /> r. n <br /> fps rank tested? esa ailed precision test 7 es a If yes, give date(s), <br /> cos a repair made to the tank system? es No f yes; what was repaired? <br /> �F <br />:ns repair done under inspection? es o ere soil samples anatyxed7 es o TXE PH-G P11-0 b/EDB <br /> ype of failure/discharge atastrophic long-term teakage verfiit known cher: <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FCR.LEACHtNG POTENTIAL ANALYSIS) t <br />'oft Samples Received es o epth to Groud Vater ZO of/Year $ verage Ar;nuat Precipitation re0-25 <br /> r,-Site Wells) es o umber S Type [rr om tub <br /> S core 5 " core S Bore <br /> istance to Vett(s) from Tank ft; :,' ft; ii ft C 10 pts C 9 pts C i pts l <br /> O if O if O f <br /> ' R orl tion R comition R ondition <br /> Site Features- Leaching Potential Ar.atysIs Ej E is met E his mer E s met <br /> inimm Depth to:grourdwater from the Soil Sample (feet) E >100 1, 51-100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) Hone Unknown 3resent <br /> F <br /> verage Annual Precipitation (inches) Cxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> i <br /> nn-Made conduits which increase vertical migration <br /> I lrachate (i.e:, septic systems, water wells, ponds) None I Unknown DIresent <br />-licrie site features: Recharge area, coarse soil, nearby wells. At least ore�than <br /> jxxxx None one: one i <br /> ,' COLUMN TOTALS>>>TOTAL:IIPOINTS +" ; _ - <br /> impte Result: (B T X OR E) j RANGE OF TOTAL POINTS .9 pts or more 4T 48 pts 40 pts or. less } <br />�TY 4 i✓ <br /> is e T X E B T X E <br /> s MAX[" ALLOWABLE B T X E LEVELS (;PH), 1 SO 50 5Q -3 .34 1. t. HA\3 <br /> t <br /> imple Result: GASOLINE 1000 100 10 <br /> J� AXIHUH ALLOWABLE TPH LEVELS (PPM) <br /> TPH/p13 i IESEL 10,000 1000 10O <br />:OTNOTE 5: '•••If documented soil and/or ground water contamination is present,' do not complete the leaching potential <br /> I 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 D points. If depth <=5 ft., do not use table. <br /> A2 If precipitation is > 40 inches, score O points. <br /> 13 Levels for BTX&E are not' applicable at a`,TPH concentration of 10 pp<n (gasoline) or 100 ppm (diesel).. <br /> STAFF RECOWENDATION/CCNCLUSION �+ <br /> Are 8TX d" E or-TPH Concentrations > Allowable Levels Tes X o <br /> RecA m erd Site Closure es o 'I If Yes, Refer to Site Mitigation'Tar Evaluation r u''fo-vku m 3 0 <br /> REVIEW EVALUATICN - TO BE CCHPLETED BY A SUPERVISOR/SENIOR <br /> CHCUR WITH STAFF RECOMMEHOATION FOR CLOSURE rES fO EFERRED TO SITE MITIGATION FOR EVALUATICH ES O <br /> ATE REFERRED j / / ATE CLOSURE LETTER MAILED <br /> .F nF <br /> rnr.rJn1CR i� €:. r <br /> 4 23 80 (UGTVKSHT)\5/90 <br />