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SAN :OAOUIN C.^..); 8LIC HEALTH SERVICES/E.4VIRC4MENTAL HEALTM •iSICH <br /> U RXSME:T FOR SITE CLOSURE EYALUATICN .4 ATE I� 9�gz <br /> Nnr.E Of FACILITY I � (!O,vr�jyLcfj� + COIH JEEPS CCCE <br /> j+nORESS soo ANz ID .1 - 3 <br /> �ANX SIZE UEL TYPE <br /> CUSIAL SITE HISTORY <br /> s permit current7 es o —Fermi acitity status code oe.Soil/GW Cont es o <br /> Nuncer of tanks at facility ge of Tanks(if available) ype of tank Leel brgt nqt Dual <br /> I. TANX HISTCRY <br /> 'Uas Tank tested? es a ailed precision test 1 es o If yes, give date(s) <br /> was a repair made to the tank system? es No f yes, what was repaired? <br /> .:as repair done under inspection? lyes o ere sail samples analyzed? es o TXE PH-G PH-0 b/EDB ' <br /> 'ype of failure/discharge atastrophic tong-term leakage verfitl cher: <br /> • <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Toil Samples Received i es o epth to Graund 'later of/Year ; verage Amual Precipitation - `IG 0-25 <br /> Dn-Site Wells) Ires I a I umber L Type I irr om <br /> S core s core s core <br /> )istance to Wells) from Tank ft; ft; ft C 0 pts C 9 pts C pts <br /> 0 f 0 if 0 f <br /> R ondition R condition R ondition <br /> J. Site Feature - Leaching Potential Analysis E 's met E is met E s met <br /> iiniaum Depth to groundwater from the Soil Saapte (feet) >100 I )-100 I 0 125-50\1 <br /> =ractures in subsurface (applies to foothills or mountain areas) r() None Unknown resent <br /> :vcrage Annual Precipitation (inches) CxXxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> tan-Made conduits which increase vertical migration <br /> )f leachate (i.e., septic systems, water wells, ponds) None unknown resent <br /> 'nique site features: Recharge area, coarse soil, nearby wells. ( Q At teas-, l 4ore than <br /> xxxxxx None / one one <br /> COLUMN TOTALS>»TOTAL POINTS tv ♦ 27 • 3 <br /> ;ample Aesu tC: (B T X OR E)0314 RANGE OF TOTAL POINTS 9 Pts or more 41 - Ga Pts GO pts ss <br /> 15 TO 7` 'x'40 <br /> — B T X E 6 T X E <br /> % G g lrt O MAXIMtM ALLOWABLE a-T-X-E LEVELS (PPM) 1 50 So 50 .3 .3 1. 1. NA\3 <br /> Sample Result: II OLINE 1000 100 10 <br /> ffAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> /700 TPH II IESEL 10,000 1000 100 j <br /> 'COINOTES: ••'If documented soil and/or ground water contamination Is present, do not complete the teachpotentia <br /> analysis. (I.e., site is currently on UGT Contamination List for soil or gror+d water. <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <4 ft., do not use table. <br /> \2 If precipitation is > GO inches, score 0 points. <br /> \3 Levels for BTXLE are not applicable at a TPH concentration of 10 Ppm (gasoline) or 1GO ppm (diesel). <br /> • STAFF RECOPHENOATICN/CCNC.USION <br /> 1. Are BTX ; E or TPH Concentrations > Allowable Levels Yes11 o <br /> 2. Re^_:amerd Site Closure es iia f Yes, Refer to Site Mitigation for "evaluation <br /> REVIEW EVALUATION - TO BE CCMIPLETED BY A SL'PERVISCR/SEHICR <br /> t:CHCUR WITH STAFF RECCMMEHDATION FOR CLOSURE lyE50 EFERRED TO SITE HITICATICH FOR EVALUATION lyE'a <br /> PATE REFERRED /( / ' .ti- ATE CLOSURE LETTER MAILED <br /> i <br /> iinnE OF <br /> �:VALUATCR <br /> LH 23 80 (UGTW%SHT)\5/90 <br />