Laserfiche WebLink
SAN JOAQUIN ATY PUaLIC HEALTH SERVICTS/EUVrRONMENTAL HEA - DIVISION <br /> UGST WORKSHEET FOR SITE CLMRE EVALUATION DATE <br /> iNAME OF FACILITY (f,4 / <br /> I - SWEEPS CCOEi <br /> ADORSSSJ �3 / I C;�?3 <br /> + 7 Si 6e� 2) ej, 6,�,g6 , S ) TANK ED <br /> TANK SIZEJ FUEL YPE1 Rora4d 0 <br /> Z24 � p� 4 <br /> 11 , GENERAL SITE HISTORY <br /> Is permit current? i Yes x Nal Permi ;aciLizy status code Ooc .sait /CW Corr Yes No <br /> 1 1XI <br /> Nmoer of Tanks at faciLity Age of Tanks( ff avakabte ) j Z,�,�&klType of Tank ! St" L2 Forgtl Sngt Dust <br /> III , TANK HISTORY <br /> Iwas rank tested? Yes X No i Faited precvsion test ? i Yes go lxl If yes , give dare( s ) I <br /> Fwa 5 a repair made to zhe vcank system? Yes No if YeSp What Wa� repaired7 <br /> lWas repair done under inspection? Yes Mal Were sak san�otes amiyzea7 Y es No 3TXEj ITPH-� j <br /> Type of faiLure/discharge ' cataszrawic Long- term ( eakage over�, i I I <br /> unknowri ornero,— <br /> IV , REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/CCLI,:CT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> I I I <br /> SoiL sam ( es Received Yes No Death to �roura Water Ref/Year Average AnnuaL Precipicati A= 14 10- 251 <br /> On- Sitm WeLL ( s ) I Ye.a I No I lNumoer 7ypel llrrl Dom Puo S Score 3 Scare S Scare <br /> Distance cc WeMs ) from iank <br /> � rt ; �fz; �ft C To ats 9 nts; C 5 jars; <br /> a if if if <br /> I ion icni ion <br /> A condi c R Condit 11 cmndi t <br /> i iV , Site Feature Leaching Potent <br /> iaL Anatysis a is met <br /> is met <br /> is mer <br /> iMini � Depth to groundwater ioromn the SciL SamaLe ( feecl ' 51 - 100 25 -50\ 1 <br /> ! Fractures in sudsur�aca ( apptie� to foorhiLts or mountain a Ime Unknown Present <br /> lAverage Annuat Precipitation ( inches ) 0 <br /> 10 - 25 m-40\2 <br /> Mari-4ade conduits which increase verricat migr3tion <br /> lof teachaze ( i . e . , septic systems , water weUs , Fonds ) Une Unknown Present <br /> k <br /> jUnique size -Ieatures : Recharge area , coarse saiL . nearby wet (s. At ( east IMare than <br /> .4we we one <br /> �rK3k-� T � i .,+ LDB � c:5kvY - <br /> COLUMN OTALS>>> i A POINTS <br /> 1,ff A A I I 1 = <br /> Samte ResulCv ( 3 T X OR E) RANGE OF TOTAL POINTS149 pro or mary 4-a Pts 40 ars or Less <br /> a <br /> ED 13 � i 0 31 r I X 1 5 1 1 1 7 x <br /> MAXIMUM ALLOWABLE 3� i �X-z LEVELS (PP14) I 5a 5a 50 ..3 3 10 14 NA\.3 <br /> Sa6�te ResuVt�� "i GASOLINE icaa Ica 4 a <br /> k5 F, ;; ? I? SOL'N8 <br /> 00LIMUN ALLCUABLE TPH LEVELS (PPH) <br /> 4f� D I ESEILL loroca�l- 100C laa <br /> FOOTNOTES , � If docuoenzed scit and/or ground water contamination is pres�mnt , do not campterm the Leaching patentiaL <br /> anaLYSIS� Clae� j site is aurrentiy an UGT COmmination List for sail, or ground water . ) <br /> \ 1 If depth is > 5 ft� and < 25 ft. , scare 0 mintsm if death �5 ftmr do not use Zabiem <br /> \2 If Precipitation is > 4a inches , scare 0 poinrs� <br /> \3 Lavets for BTUE ace not aPPUcabLe at 3 TPH COmentrztim of TO opm (gasatine) or ma PRn (dfasei ) . <br />/I . STAFF R5COMMENDATICN/MNCLUSION <br /> 1 , Are M E or TPH Concentrations > ALLowabke Levets *Ye <br /> ST Imal <br /> 2 . RecomMend Size Closure Yes Mal L* lf Yes , Refer "a Site Mitigation for Evaluation <br />(11 , REVIEW EVALUATION - TO 3E COMPLETED 3Y A SUPERVISCR/"� IOR <br /> CONCUR WITH STAFF RECCMMEAIDATTCH FOR CLOSURE YES ! NGI REFERRED TO SITE MITIrATION FOR �NALLIATIONiYES ' <br /> I I i I I <br /> DATE REF=F!RED DATE CLOSEIRE LETTER MAILED <br /> NAME OF <br /> EVALUATORI <br /> 23 SO 1UGTWKSHT1151110 <br />