Laserfiche WebLink
SAN ,IOAQUI. NTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL hH DIVISION <br /> I UGST WORKSHEET FOR SITE CLOSURE EVALUATION (DATE <br /> (NAME OF FACILITY5o u Za LLC $ SWEEPS CODE <br /> IADORESs jailW, i-k1� r,�-� �rQ TANK 10 4 - bs <br /> (TANK SIZE <br /> FUEL TYPE 1' <br /> Ii. GENERAL SITE HE Y <br /> Is permit current? Yes No ermit # - Facility Status Code Dac.SciL/GW Cont Yes No <br /> Number of Tanks aL facility 2 Age of Tanks(if available) lA.l k I Type of Tan Steel FbrgI ngl Dual <br /> III. TANK HISTORY nQ dASCDY� <br /> Was Tank tested? Yes No ailed precision test ? Yes No If yes, give date(s) <br /> !Was a repair made to the tank system? Yes No If yes, what was repaired? <br /> :Was rep�failu:re/discha�rge <br /> done undertion? Yes No Were soil samples analyzed? Yesl No BTXE� TPH-G TPH-D P6/EDB <br /> Type ofcatastrophiclong-term leakage overfill unknown other: <br /> TV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FORhLEACHING POTENTIAL ANALYSIS) <br /> ISoi[ Samples Received Yes No Depch aGroundter Ref/Year ; Average Annual Precipitation A= 14EOn-Site Wells) Yes Ha Number & TyDom Pub <br /> S j;Score S Score S Score <br /> ;Distance to Wells) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 E: if 0 if 0 if <br /> R 1. condition R condition R condition <br /> V. Site Feature Leaching Potential AnaCysis <br /> E is met E is met E is met <br /> ;Minimum Depth to groundwater from the Soil Sample (feet) >10D 51 10D $ 25'50\1 <br /> ,Fractures in subsurface (applies to foothills or mountain areas) 1� i None <br /> Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 14 25 xxxxxxxl 26-40\2 <br /> Man-Rade Conduits which increase verticat migration �r Unknown Present <br /> of leachate (i.e., septic systems, water wells, ponds) O i None <br /> At least More than <br /> :Unique site features: Recharge area, coarse soil, nearby wells. i <br /> xxxxxx None � one one <br /> COLUMN TOTALS>>>TOTAL POINTS <br /> Sampte R suit• (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> TA 'X`-�•� a T' X E 8 I X E <br /> �.- MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 5D 50 .3 J.T <br /> 3 i! 1. 1. NA\3 <br /> SQaqmple Reset[: GASOLINE 10DD 100 10 <br /> MAXIMUM ALLOWABLE TPH LEVELS (PPM) 100 <br /> 01ESEL 10,000 1000 <br /> FOOTNOTES: ***If documented soil and/or ground water contamination is"Present, do not complete the leaching potential <br /> analysis. (i.e., site is currently on UGT Contamination List for sail or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. it p� ppm (diesel). <br /> \3 Levets for BTX&E are not applicable at a TPH concentration of 10 (gasoline} or 100 <br /> VI. STAFF RE?COMMENOATION/CONCLUSION <br /> 1. Are BTX & E or TPN Concentrations > A[towable Levels 'Yes No <br /> 2. Recommend Site Closure Yesl No F *if Yes, Refer to site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR EE <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YE5Ho <br /> DATE REFERRED / 23 /� DAT CLOSURE LETTER MAILED !� / F! <br /> NAME OF i <br /> EVALUATOR <br /> £H 23 80 (UGTWKSHT)\5/90 <br />