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SAN JOACUIN COUNTY FSC HEALTH SERVICES/ENVIRCNMENTAL HEALTH O V"'*OH <br /> UGST ;.*.,.,.SHEET FOR SITE CLOSURE EVALUATIONATE <br /> mE OF FACILITY Lr s A, �?� EEPS CODE i <br />)RESS � j �(,(J C� AHK IO x <br /> NX SIZE UEL TYPE <br /> GENERAL SITE HISTORY <br /> permit current? es o ermit # aeility Status Code oe.Soil/GW Cont as N0 <br /> mbar of Tanks at facility ge of Tanks(if available) I ype of Tank teel I 1FbrqL ngl Dual <br /> TANK HISTORY <br /> s Tank tested? es IFailed precision test ? es o If yes, give date(s) <br /> s a repair made to the tank system? IYes No f yes, what was repaired? <br /> s repair done under inspection? es o ere soil samples anatyzed? es Io TXE IT PN-G PH-0 b/EDD <br /> i <br /> pe of failure/discharge atastrophic long-term leakage verfill ndwn *.her: <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT ?ATA FOR LEACHING POTENTIAL ANALYSIS) <br /> it Samples Received es o epth to Ground Vater Itof/Tear ; verage Arcual Precipitation s 4 10-25 <br />-Site Idetl(s) ITes o umber 3 Type lrr em b <br /> S care S earn S core <br /> stance to Well(s) from sank ft; ft; ft C 0 pts C 9 pts C pts <br /> 2 ondreien R ondition i ondition <br /> Site Feature - Leaching Potential Analysis E met E is met E s met <br /> nimum Depth to groundwater from the Soit Sanpte (feet) I >100 1-100 25-50\I <br /> actures in subsurface (applies to Foothills or mountain areas) bone G? Unknown resent <br />•erage Annual Precipitation (inches) XXXXXX 1410 9 10-25 xxxxxx 26-40\2 <br />,n-Made conduits which increase vertical migration <br /> Leachate (i.e., septic systems, water wells, ponds) Q None Unknown I resent <br /> Ocue site features: Recharge area, coarse soil, nearby waits. At Least ore than <br /> XxXx None One one <br /> COLUMN TOTALS»>TOTAL POINTS /c- + L L. q�—, <br /> mole ResuLt: (3 i X OR E)p RANGE OF TOTAL POINTS 9 pts or more 1 • 48 s I GO pts or Less <br /> � �•3 � 43 .0 <br /> B 1 T I X E 3 T X E <br /> T�l!•d - iZ� MAXIMUM ALLOWABLE 3-T-X-c" LEVELS (PQM) 1 50 50 50 .3 .3 1- 1. NA\3 <br /> imRle Result: L[NE 1000 100 10 <br /> AXI" ALLOWABLE TPH LEVELS (PPM) <br /> 170 TPH � rr:sEL 10,000 toxo too <br /> ZrNOT'cS: *"If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (i a., site is currentty an UGT Contamination List for soil or ground water,) <br /> \1 if depth is > S ft. and t 25 ft., score O points*. If depth t=5 ft., do not use cable. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX&C are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECOWENOATION/CCNCLUSION <br /> Are 3TX 3 E or TPH Concentrations> Allowable Levels Yes �'o <br />!- Recommend Site Ctosure es I o I �/ If Yes, Refer to Site Mitigation for evaluation <br /> REVIEW :VALUATION - TO SE C24PLETED 3Y A SUPERVISOR/SENIOR <br />:ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE E5 O I EFERRED TO SITE MITIGATION FOR EVALUATION �ES <br />,ATE REFERRED i 'Ali? CLOSURE LETTER MAILED <br /> 4 <br />':ALUAIcP <br />