Laserfiche WebLink
T / <br /> SAN JOAOUIN •v PUBLIC HEALTH SERVICES/ENVIRCNMENTAL HEJ VISION <br /> • <br /> NAME OF FACILITY C�d _. SHEET FOR SITE CLOSURE EVALUATION pp;� <br /> SWEEPS CODE <br /> ADDRESS J f_ TANK [4 x T1 <br /> ,( TANK SIZE _b ` OC) FUELTYPE d SD / ✓ V <br /> ' EI. GENERAL SITE HISTORY r <br /> Is permit current? Yes No Permit 0 - Facility Status Code Doc.SoiE/GLI Cont Tes No <br /> Number of Tanks at facility Age of Tanks(if available) Type of Tank Steel Fbrgl Sngt Dual <br /> III. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test 7 Yes No If yes, give dates) / <br /> Was a repair made to the tank system? Yes #0 If yes, what was repaired? <br /> Was repair done under inspection? Yes Noi Were soil samples analyzed? Yes No 8TXE ITPN-G ITPH-0 Ptr/EDa <br /> i Type of failure/discharge catastrophic (long-term leakage overfill unkrur, other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION t 5 TE OET ILS COLLECT T F CHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water q0 Ref/Year Average Arcual Precipitation A= 14 10-25 <br /> I <br /> On-Site Welt(s) Yes No Number Ii Type Irr xDan Pub <br /> S Score S Score S Score <br /> Distance to WeLL(S) from Tank 1000 ft; 2w ft; ft C 10 pts C 9 pts C 5 pts <br /> I 0 if 0 if 0 if <br /> R condition R condition R' condition <br /> V. Site Feature - Leaching Potential Anatysis E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sacple (feet),= - >10051-t00 1 � 25-50\1 <br /> Fractures in subsurface (applies to foothitts or mountain areas) None Unknown I +� !Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-401,2 <br /> Man-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water welts, ponds) None unknown r Present <br /> Unique site features: Recharge area, coarse sail, nearby welts. I At least More than <br /> xxxxxx None one ase <br /> COLUMN TOTALS>>TQTAL POINTS i + a ♦ (_ <br /> S '' te suit: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 40 pts or Less <br /> $ <br /> a:5.E 6 ;:- 11?. Lt <br /> ' ;5d-It X 44&y,-'-r I1 MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50� 50 .3 E 1"'S J.3 1.1 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 <br /> a3 � MAXIMUS! ALLOWABLE T?H LEVELS (PPM) <br /> 13 �� TPH DIESEL 10,000 1000 100 <br /> FOOTNOTES: if documented soil and/or ground water contamination is present, do not complete the teaching potential <br /> analysis. (i.e., site is currently on UGT Contamination List for sail 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 8TX&E are not appticabie at a TPH concentration of 10 ppm (gaso(ine) or 100 ppm (diesel). <br /> I <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX Ii E or TPN Concentrations > Allowable Levels *Yes <br /> 2. Recommend Site Ctosure Yes No If Yes, Refer to Site Mitigation for Evacuation �v <br /> VII. REVIEW EVALUATION - TO 8E COMPLETED 8Y A SUPERVISOR/5 IOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSUREIYES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES 4,rNOI <br /> DATE REFERRED / / jDATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />