Laserfiche WebLink
SAN JOAQUIN PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE. �"'71VISION <br /> [, WORKSHEET FOR SITE CLOSURE EVALUATION DATE G <br /> NAME OF FACILITY �� Q /�,' SWEEPS CODE 3 <br /> TANK ED <br /> ADDRESS �! <br /> TANK SIZE `6)PD� FUEL TYPE C L <br /> I1. GENERAL SITE HISTORY <br /> Is permit current? Yes NoX VV <br /> Permit # Facility Status Code DOc.Soil/GW Cant Yes No <br /> Number of Tanks at facility Age of Tanks(if available) 4� Type of Tank Steel FbrgL Sngl Dual <br /> 111. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test ? Yes No If yes, give date(s) V/ <br /> Was a repair made to the tank system? Yes No If yes, what was repaired? �Q 5'5c ( i!( <br /> Was repair done under inspection? Yes)<' No Were soil samples analyzed? Yes No BTXE TPH-G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic fang-term leakage overfill unknown other:IA/vx u� % j <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water 9 Ref/Year 7 ;�b Average Annual Precipitation A= 14 .10-25 <br /> On-Site Wells) Yes No xi Number & Type Irr Dom Pub <br /> 5 Score S Score S Score <br /> Distance to Welt(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) D None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-made conduits which increase vertical migration EI <br /> of leachate (i.e., septic systems, water wells, ponds) None C Unknown Present <br /> Unique site features: Recharge area, coarse soil, nearby wells, l C At least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS L !� + 1 + _ 37 <br /> Sample Result: (B T X OR-E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or Less <br /> Uje tec �� <br /> 21 :50 <br /> E B T X EMAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 50 .3 .3 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 <br /> MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> O DIESEL 10,000 1000 100 <br /> FOO NOTES: ***( documented soil and/or ground water contamination is present, do not complete the leaching iat <br /> L =3 ranalysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br /> // If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft,, do not use table. <br /> Alf precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> vE. STAFF RECOMMENDATION/CONCLUSION 16 <br /> _ 1-5- `7 7 <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels *Yes No ,4 <br /> 2. Recommend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR 4 <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 2 80 (UGTVKSHT)\5/90 <br />