Laserfiche WebLink
/ SAN JOAQUIN Ct,ffl-� PUBLIC HEALTH SERVICES/ENVIRQNMENTAL HEAL,'* VISION <br /> UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE `� 47/ <br /> /AC[LITY 0 ,� j �,r EEPS_ OOE �_P e7 <br /> (--TANK ID 0 <br /> /S IZETYPE /G 2.1 — O Z <br /> / NERAL SITE HISTORY—,...__--' <br /> es <br /> s permit current? es o ermit IR - acility Status Code oc.Sai[/GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) I IType of Tank Leel I Fbrgl I 1SN( ,at <br /> III. TANX HISTORY <br /> as Tank tested? es oailed precision test 1 Yes o If yes, give date(s) <br /> as a repair made to the tank system? 'eV No f yes, what was repaired? [1/AO <br /> is repair done under inspection? es o ere soil samples analyzed? es I o I)e' TXE PH-G PH-0 b/EDB <br /> ype of failure/discharge atastrophic long-term leakage verfill -!fawn Cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received eso epth to Ground eater 13s of/Year 576 83 verage Annual Precipitation <br /> -Site Wells) IYes o umber S Type irr cm ub <br /> S core S core S care <br /> istance to Wells) from Tank ft; _f t; ft C 10 pts C pts C pts <br /> O .f 0 if 0 f <br /> R ondition R ondition R ondition <br /> q. Site Feature - Leaching Potential Analysis E s met E is met E s met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1-100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown >resent <br /> verage Annual Precipitation (inches) Cxxxxx <10 9 10-25 xxxxxx 26-40\2 <br /> an-Made condLjits uhich increase vertical migration <br /> F leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> ]nique site features: Recharge area, coarse soil, nearby wells. At least iore than <br /> Kxxxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS '(f + <br /> a le R suit: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> �06" t; 3 OPP04 <br /> B T X E 6 T X E <br /> MAXTMLIM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. HA\3 <br /> ample Result: ASOLINE 1000 100 10 <br /> a� OITPH 4AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> IE SEL 10,000 1000 100 <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 soil 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. <br /> \3 Levels for BTXdE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOWENDAT I ON/CONCLUS ION �r/j v�✓?� <br /> 1. Are BTX $ E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recomnend Site Closure Fes r o If Yes, Refer to Site Mitigation for =valuati— <br /> VII. <br /> REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOHHENDATION FOR CLOSURE E5 0 EFERREO TO SITE MITIGATION FOR EVALUATION fES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> 1nPC OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />