Laserfiche WebLink
SAN JOACUIN C, f PUBLIC HEALTH SERVICES/ENViRCNMENTAL HEAT (VISION - <br /> 1. UGST WCRKSHEET FOR SITE CLOSURE EVALUATION ATE Z� <br /> nME OF FACILITY G �—' <br /> -EPS CCOE <br /> OORESS ANK ID 4 - (r O <br /> InNK SIZE FUEL TYPE <br /> (;. GENERAL SITE HISTORY <br /> Is permit current7 es o ermit 4 - acility Status Code ,�� oc.Soit/GW Cont es o <br /> ember of Tanks at facility Q ge of Tanks(if available) ype of Tank teel Fbrgl ngl Dual <br /> III. TANK HISTORY <br /> as Tank tested? es o ailed precision test 7 es o If yes, give date(s) <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> 'as repair done under inspection? es o ere soil samples analyzed? iY es o TXE PH-G PH-0 b/EDB <br /> Iype of failure/discharge atastrophic long term leakage verfill nknown Cher: <br /> f IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es o epth to Ground Water '� of/Year �6 ;� verage Annual Precipitation = 4 0 25 <br /> n-Site Well(s) es o umber L Type irr om ub <br /> S core S Score S Score <br /> istance to Well(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R rorAition R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> linimum Depth to groundwater from the Soil Sample tfee t)L(� Q R / >100 1-100 Q 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None I Unknown resent <br /> verage Annual Precipitation (inches) xxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> Df leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> )nique site features: Recharge area, coarse soil, nearby wells. I At Least More than <br /> xxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS 2 G <br /> a,Qmple Res lt: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> �;6 ��p" 6 T X E B T X E <br /> f �h MAXiMLH ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> ample Result: ASOLINE 1000 100 10 <br /> 3 <br /> AXIMUM ALLOWABLE TPH LEVELS (PPM) 100' IG 1 <br /> TPH IESEL 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 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 BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECCMENDATICN/CCNCLUSION <br /> 1, Are BTX 3. E or TPH Concentrations > Allowable Levels Yes <br /> 2. Recommend Site Closure es o (f Yes, Refer to Site Mitigation for Evaluation '466' <br /> VII. REVIEW EVALUATIC44 - TO BE CCHPLETED BY A SUPERVISOR/SE4IOR <br /> 04CUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> )ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> TAME OF <br /> :VALUATOR <br /> EH 23 80 (UGT"SHT)\5/90 <br />