Laserfiche WebLink
SAN JOAOUIN COUNTY *C HEALTH SERVICES/ENVIRONMENTAL HEALTH D10ON <br /> UGST W. _.SHEET FOR SITE CLOSURE EVALUATION ATE ?/ <br />°E OF FACILITY .Ct�1lU/ L//VLA � EEPS CODE / (� <br />)RESS 7 C( / ANK IO Al /� ( C/ —� If <br /> VK SIZE �O V UEL TYPE <br /> GENERAL SITE HISTORY _ <br /> permit current? es o ermit B acility Status Cede cc.SoiI/GW Cont es to <br />"r of Tanks at facility ge of Tanks(if available) I ype of Tank teel Fbrgl ngl I Dual <br /> TANK HISTORY <br /> s Tank tested? as o ailed precision test ? es o 1f yes, give dace(s) <br /> s a repair made to the tank system? as No f yes, what was repairedf <br /> s repair done under inspection? es 4o Mere soil samples analyzed? es to TXE PN-G PH-0 1PwEDG <br /> trophic Long-term leakage verfill I nam cher: <br /> pe of faiLure/discha rge FE—tas <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> iil Samples Received es o epth to Ground water of/Year verage Annual Precipitation < 10.25 <br /> i-Site uell(s) as o umber 3 Type Irr I bom b <br /> S core S core 5 core <br /> stance to .Jetl(s) from Tank ft; ft; ft C 0 pts C �9�9 pts C pts <br /> 0 f O if 0 'f <br /> R kmdition R Il�ordition R ordition <br /> Site Feature - Leaching Potential Analysis E s met E Is met Es met <br /> inimum Oepch to groundwater from the Soil Sample (feet) I >100 1.100 25.50\1 <br />•actures in subsurface (applies to foothills or mountain areas) / 0None Unknown resent <br />,crage Annual Precipitation (inches) xxxx <10 9 10.25 `U`X=x 26.40\2 <br /> nn•Made conduits which increase vertical migration <br /> leachate (i.e., septic systems, water wells, ponds) Mme Unknownresent <br /> iuve site features: Recharge area, coarse soil, nearby wells. At leastaor <br /> xxxx Mme p oneCOLUMN TOTALS»>TOTAL POINTS Jo ' 3b -mpl�e�//Result: (D T X OR E) RANGE OF TOTAL POINTS 9pts or more I L1 • 48 pts)I` .3 G G T X E 3 T X E <br /> 93 k O SMAXIML14 ALLOWABLE O-T-X-EE LEVELS (PPM) 1 50 505 .331. 1.le Result: SOL(NE 1000 100 <br /> AXIMIN ALLOWABLE TPH LEVELS (PPM) IESEL 10,000 1000 100 <br /> two TPH <br /> r <br /> NOTEES: ..If documented soil and/or groundwater 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., scare 0 points'. If depth r5 ft., do not use table. <br /> \2 If precipitation is > 4o inches, scare 0 points. ppm (gasoline) or 100 ppm (diesel). <br /> \3 Levels for 3TX&E are not applicable at a TPH concentration of 10 <br /> STAFF RECOWFUDATTON/CONCLUSION <br /> I. Are 3TX 3 E or TPN Concentrations > Allowable Levels Yes 001 <br /> 2. Recomnend Site Closure es o If Yes, Refer to Site mitigation for Evaluation <br /> REVIEW EVALUATION - TO 3E COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR 41TN STAFF RECDMMENDAT ION FOR CLOSURE FES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES JO <br /> DATE REFERREC AfF CLOSURE LETTER MAILED <br /> 7 ALJ ICP <br />