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SAN JOAQUIN COUNTY IC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> UGS MEET FOR SITE CLOSURE EVALUATION DATE <br /> NAME OF FACILITY / GA SWEEP E <br /> AOORESS l� o S' / �c i� TANK IO 9 - <br /> iTANK SIZE 2 C2CV FUEL TYPE <br /> ;I. GENERAL SITE HISTORY <br /> Its permit current? Yes No Permit 0 - Facility Status Code Doc.Soil/GW Cont Yes No <br /> jNUMber of Tanks at facility Age of Tanks(if available) Type of Tank Steel FbrgL Sngl Dual <br /> ili. TANX HISTORY <br /> Was Tank tested? Yes No Failed precision test ? Yes No If yes, give date(s) <br /> Was a repair made to the tank system? Yes No If yes, what was repaired? <br /> 'Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE TPH-C TPN-D Pb/E08 <br /> x of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water Ref/Year ; Average Annual Precipitation A-114 10-25 <br /> On-Site Well(s) Yes No Number & Type Irr 100ml Pub <br /> S Score S Score S Score <br /> Distance 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 condition R condition R condition <br /> v- Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> IMinimum Depth to groundwater from the Soil Sample (feet) >100 51-100 O 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present <br /> Average ArMal Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water walls, ponds) /f O None Unknown present <br /> unique site features: Recharge area, coarse soil, nearby wells- p At least Mort than <br /> xxxxxx None ( one one <br /> JCOLUMN TOTALS>»TOTAL POINTS 10 Z7 O =3 7 <br /> Sample Result: (3 T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 o Less <br /> B T X E 3 T X E <br /> MAXIMUM ALLOWABLE 6-T-X-E LEVELS CPPM) 1 50 SO SO .3 .3 t. 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 / <br /> MAXIMUM ALLOIIABLE TPH LEVELS (PPM) 100 <br /> c73— M06 OTPH OIESEL 10,000 1000 <br /> FOOTNOTES: If documented soil and/or ground water contamination is present, do not complete the leaching potentiat <br /> L analysis. (i.e., site is currently on UGT Contamination list for soil or grand water.) <br /> \1 If depth is > 5 ft. and < ZS ft., score 0 points. If depth <.5 ft., do not use sable. <br /> S'1aC �� \2 If precipitation is > 40 inches, score 0 points. <br /> U \3 Levels for 8TXSE are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. AFF RE ENDATION/CONCLUSION Wa c� <br /> 1. Are BTX t E or TPN Concentration > Attowabla Levels 'Yes o V / <br /> 2. Recamoerd Site Closure Yes No If Yes, Refer to Site Mitigation for Evaluation <br /> VtI. REVIEW EVALUATION - TO 3E COMPLETED RY A SUPERVISCR/SENICR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION TES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER Ml1ILE0 / / <br /> HOE OF <br /> EVALUATOR (� <br /> EN Z3 80 (UGTWKSHT)\5/90 <br />