Laserfiche WebLink
N Aw, <br /> M SAN JOAQUIN �JTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEh_ , n DIVISION <br /> 1 . UST WORKSHEET FOR SITE CLOSURE EVALUATION ATE IOC <br /> AME OF FACILITYNo CORD IO 1 "V / / <br /> OOP•ESS I N� c //qe� ANK ID 61 - <br /> , ANK SIZE D oo UEL TYPE <br /> I1 , GESIERAL SITE HISTORY <br /> Is permit current? es aermit C - acilfty Status Code ac. Sofl/GW Cont es o <br /> �Vum=er of Tanks at facility Be of Tank( if available) Ifype of Tank teal Fbrgl mgt Dual <br /> III , TANK HISTORY <br /> 'as Tank tested? es �l0 ailed precision test 7 as �lo If yes , give <br /> as a repair made to the tank system? es No f yes , what was repaired? <br /> �as repair done under inspection? Iles �la Jere soil samples analyzed? es �7o TXE I PH-G PH-D b/E08 <br /> ype of failure/discharge atastrophic Ilong ,tern leakage verfill nown ther: <br /> IV . .REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oii Samples Received es a epth to Ground Water of/Year verage Annual Precipitation = 4 0- 25 <br /> Site uell ( s ) �'es I o �lUmber S Type Irr I ub 1 . <br /> 5 5 core S core <br /> istence to Wells ) from Tank tt; ft; ft C 0 pis C pts C pts <br /> 0 f 0 if 0 f <br /> R ondit <br /> ion R ondit <br /> i on R ondition <br /> Site Feature - Leaching Potential Analysis Icomre <br /> s t .. is met s met <br /> inimum Depth to groundwater from the Sail Sample ( fear) 30 , 44 a ) I >100 I 1 ' 100 I O 25- 50.\1 <br /> Fractures in subsurface ( applies to foothills or mountain areas ) None Unknown resent <br /> I <br /> gverage Annual Precipitation ( inches ) xxxx= I <10 9 10-25 =xxxx 26-4.0L <br /> II�Aan-Made conduits which increase vertical migration <br /> or leachate ( i . e. , septic systems , water wells , ponds ) D None Unknown resent <br /> Unicue site features : Recharge area, coarse soil , or wells. At least ore than <br /> lM•.rcipal =>2000 ft; jdomcesstic=>500 ft; irr/agricultural=present] xxxx more one one <br /> Y16 X ;: <br /> 3r3 ✓ COLUMN TOTALS>>> TOTAL POINTS D + <br /> ole Result : (8 T X OR E ) RANGE OF TOTAL POINTS 9 pts or more I 41 48 pts 40 pts oroles <br /> �rK _ 4 IIr -�(alc� moo+. g X E B T X E l <br /> 7g'g1YC- 1 MAXIMUM ALLOWABLE B-T-X-c LEVELS (PPM) 7 50 i0 50 .3 .3 1 . 1 . HAS <br /> Sa Is Result : SOLINE 1000 100 \ 10 <br /> Q (G M�yy AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> �H I� IESEL 10 , 000 1000 100 <br /> 7 <br /> FOOTNOTES : If documented soil and/or ground water contamination is present , do not complete the lea en <br /> analysis. ( i .e. , site is currently an UGT contamination List for soil or ground water . ) <br /> 1 If depth is > 5 ft. and < 25 ft. , store 0 points. If depth o5 ft. , do not use table. <br /> \2 if precipitation is > 40 inches , score 0 points. <br /> 13 Levels for 8TX8E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm ( diesel ) . <br /> VI . STAFF RECOMMENDATION/CONCLUSION 41) <br /> 1 , Are BTX 8 E or TPH Concentrations > Allowable Levels Yes o <br /> 2 . Recommend Site Llosure es o If Yes , Refer to Site Mitigation for Evaluation yY�J'a ,j- 174/7 <br /> V11 . REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/LEAD SENIOR <br /> LNCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES tV0 <br /> ATE REFERRED I / I 1ATE CLOSURE LETTER MAILED <br /> E OF <br /> VALUATOR <br /> EH 23 80 ( UGTWKSHT) \5/94 <br />