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SAN JOAQUIN Y PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE DIVISION <br /> f• rr?? —al' WORKSHEET FOR SITE CLOSURE EVALUATION <br /> jnME OF FACILITY /� /� / WEEPS CODE <br /> I DDRESS �0�1 7 �7- (,I� �%7 �u71 ANK TD <br /> TANK 512E - ��� UEL TYPE '4c1 Sf�GI cµ�wJcl✓t- <br /> fl. GENERAL SITE HIST�IRY <br /> Is permit current? eso 1 ermit /! - acility Status Code oc.Soil/GW Cont 1Y <br /> es o <br /> innber of Tanks at facility �•` ge of Tenks(if available) ype of Tank [eel Fbrgl ngI Oual <br /> Ill. TANK HISTORY <br /> ms Tank tested? es i IN. <br /> ailed precision test 7 es o If yes, give date s) <br /> as a repair made to the tank system? Yes No ilf yes, what was repaired? U St_, a J Gni --'---'>4 <br /> as repair done under inspection? es q0 ere soil samples analyzed? Yes o TXE PH-G I IT <br /> PH-D I IP <br /> b/EDB <br /> ype of failure/discharge atastrophic long-term leakage j verfill nknown I locher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es IN. <br /> epth to Ground Water of/Year I Average Annual Precipitation N= 4 0-25 <br /> i-Site WeLL(S) IYes o umber 8 Type Irr om ub <br /> S Score S Score S 5core <br /> Distance to WeIL(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 /> 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) I None Unknown 13resent <br /> verage Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None d Unknown resent <br /> lnique site features: Recharge area, coarse soil, nearby wells. At Least lore than <br /> xxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS + cJ� r + <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> B T X E B T X E <br /> t MAXIMLM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> ample Result: CASOLINE 1000 100 10 <br /> f- <br /> yl q y-.u., AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> s TPHDIESEL 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 BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECCMENDATION/CONCLUSION 4'4/;o�(i/� -f a"Id'-0 (0-"7 X <br /> 1. Are BTX 8. E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure 1Y <br /> es o "' If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION fES O <br /> )ATE REFERRED ; DATE CLOSURE LETTER MAILED <br /> DAME OF <br /> VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />