Laserfiche WebLink
SAN JOAOUIN CGINTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALiim DIVISION <br /> I UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITY WEEPS IS <br /> WEEPS CCOE ^Z '5�}� <br /> ODRESS - ('L J 5 1 1�1� �L ANK ID # ✓ <br /> TANK SIZE gJODUEL TYPE <br /> If. GENERAL SITE HISTORY <br /> ** <br /> Is permit current? Ifes o ermit # lFacitity Status Code 5L oc.Soil/GW Cont es 70 <br /> lumber of Tanks at facility ` ge of Tanks(if available) L ype of Tank tee[ Fbrgl ngl Dual <br /> III. TANK HISTORY 25•$(0 <br /> LV1-5te-ILezk 1k}p �L <br /> as Tank tested? es o iled precision test ? es o If yes, give date(s) <br /> as a repair made to the tank system? es f yes, what was repaired? <br /> as repair done under inspection? es I o ere soil samples analyzed? 1Yes I to I TXE PH-G PH-0 bJEDB <br /> ype of failure/discharge atastrophic long-term leakage verfiII nknown er: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ,oil Samples Received es IN. <br /> epth to Ground Water cf/Year verage Annual Precipitation = 4 10-25 <br /> Dn-Site Well(s) es o umber 8 Type Irr om ub <br /> S core S Score S core <br /> istance to WeIL(s) from Tank ft; ft; ft C 10 pts C 9 pts C pts <br /> 0 if 0 if 0f <br /> R ondition R condition R ondition <br /> Site Feature • Leaching Potential Analysis E is 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) KXXXXX <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 /> lnique site features: Recharge area, coarse soil, nearby wells. At least lore than <br /> xxxxx one one one <br /> COLUMN TOTALS»>TOTAL POINTS + <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS F9 pts or more 41 48 pts 40 pts or less <br /> B I T X E BIT <br /> X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 . 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 <br /> AXIMUM ALLOWABLE TPN LEVELS (PPM) <br /> �'��-�TI'�}TPH IESEL 10,000 1000 100 <br /> OOTNOTES: ***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 RECOMMENDATION/CONCLUSION Pl.e K re, Se <br /> ^ t <br /> 1. Are BTX 8 E or TPH Concentrations > Allowable Levels Yes to B--i<LF-) Io- I.5 <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Eva€cation 3 g <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE fES INO <br /> EFERRED TO SITE MITIGATION FOR EVALUATION YES 40 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />