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SAX JOAQUIN CCUKTY LIC 4EALTH SERVICSSIENVIRONMEYTAL htAUK VWIUM <br /> UGST,.WQRKSNEcT FCR SITE CLOSURE EVALUATICH DATE /_ y <br /> r,` SUE S CCOE / d l <br /> '.4A,ME OFFACILITY - <br /> iAOR£SSi c TANKIDR <br /> `.: GMIAL SITE KI-STORY ••; <br /> SIS per:nit currentt Yes No permit R Facility Status Code Doe.Soil/CW Cone Yes No <br /> ';Muer of Tanks at facility Aga of Tanks(if available) Type of Tank Steel fbrgl �Sngl Oual <br /> II. TANK HISTORY <br /> ive date(s) <br /> 2Y-as Tank tested? Yes Ko Failed ¢recision Lest t YesI No If yes, g h <br /> Was a repair made to the tank system? Yes Ko If yes, what was repaired? <br /> 'r <br /> Was repair donr .under inspection? Yes INaI Were soil samples aralyzed7 Yes NaI BTXE TPH-G �TPH-0 Pb/E08 <br /> Type of failure/discharge catastrophicLong-tern Leakage overfill unknown othtr: 'jj <br /> IV. RE:ICVAL HISTCRY (ATTACH INSPECTION REPCRT FOR SITE DETAILS/MLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Sail Sampkes Received Yes *Mo0e,pth to Crowd Vater Ref/Maar ; <br /> Average Arcual Precipitation A� 14 10-;a5 <br /> On-Site VeLL(s) Yes Nou �p'� SScate S Seore S Scare <br /> Welt(s) from Tantt; ��ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R icondition <br /> Va <br /> . Site Feature - Leaching Potential Analysis is met E is met <br /> 'e <br /> a10051-100 �, 25.50\1 <br /> Ninim�.-a Depth to groundwater from Cht Soit Sample (feet) <br /> Fractur-es in subsurface (applies to foothills or mountain areas) <br /> None Unknown '' Preserve <br /> Average Annual Precipitation (inches) <br /> ux:axx cta 4 t0-Z5 xxxxxxx 26-40\� <br /> Man-4ade Conduits which increase vertical migration None Ut�krnwn Present <br /> of Leachate (i.e., septic systems, water wells, ponds) <br /> At least �' More than <br /> Unique site features: Recharge area, coarse sail, nearby w:ils. xxxxxxi Kone one am <br /> + <br /> COLLRUI TOTALS>»TOTAL POINTS <br /> + � <br /> Sample result: (8 T X OR E) RANGE OF TOTAL ?DINTS 49 pts or more 41 - 48 pts 40 pts or LOSS <br /> A lNb SP ' SSP- i B r X E B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA13 <br /> Sacpte Result• <br /> GASOLINE 1000 100 <br /> 3 D 7n 3?/ppm, MAXIMUM ALLOWABLE TPN LEVELS (PPM) DIESEL 10,000 1000 100 <br /> TPH <br /> FOOTNaTES: "'mit documented sail anct/ar ground water contamination is present, do noC comptete the teaching potential <br /> `i analysis. (i.e., site is currently on VGT Contamination List for soil or grourxi uatar.) <br /> \1 It depth is > 5 ft. and < 25 ft., scare 0 points. If depth «'S ft., do not use tabte. <br /> :� \2 If precipitation is 1, 40 Inches, score 0 points. <br /> \3 Levels for BTXLE are not applicable at a TPN concentration of 10 MM (gasotine) or 1pp00''ppm Idgeset). <br /> Vt. STAFF RECOMMENDATION/CONCLUSION S P— 1 ��` /V 1) <br /> 1. Are 3TX b E or TPH Concentrations > Allowable levels 'Yes Ho SS . _ 7 )'YLJ <br /> jo <br /> 2. Recommend Site Ctasure Yes No 'If Yes, Refer to Site Mitigation for Evatuatton �Y �D yry <br /> VII. REVIEW EVALUATION - TO SE COMPLETED 3Y A SUPS RVISOR/SENICR <br /> FCCNCJR WITH STAFF RECCMMENDATICM FOR CLOSM YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NC <br /> ccNL- r <br /> DATE REFERRED GATE CLOSURE LETTER MAILED / / <br /> ARE F <br /> VAL'JOATCaJ�E ���` �/ ✓�-� ��' <br /> n <br /> :H 23 ?•0 (UG-,WKSHT)\5/90 <br />