Laserfiche WebLink
rw.. <br /> SAN JOADU' .NTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL H DIVISION <br /> L UST WORKSHEET FOR SITE CLOSURE EVALUATION ATE 7 � <br /> I _ ' <br /> AME OF FACILITYgnlu1 Y to ECORD ID `J34; LZ67 <br /> OGRESSa S AHK ID 0 - JC -f <br /> ANK SIZE �Q�QQ � UEL TYPE (� 'e <br /> 11 . GENERAL SITE HISTORY <br /> Is permit curren[1 as o ermit M - acility Status Code oc . Soil /GW Cont asI H <br /> o <br /> umber of Tanks at facility ] Be of Tank( if available) ype of Tank teel FbrgL ngl Dual <br /> 111 , TANK HISTORY <br /> as Tank tested? es - o ailed precision test 7 es o If yes , give date( s ) <br /> Jas a repair made to the tank system? as No f yes , what was repaired? <br /> as repair done under inspection? as <br /> o ere soil samples analyzed? es o TXE PH- G PH - D b/EDB <br /> ype of failure/discharge atastrophic long- term leakage verfill nknown ther : <br /> IV . REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS ) <br /> SOIL Samples Received as IX o epth to Ground Water / 0 of/Yea 96 verage Annual Precipitation R= 4 0- 25 <br /> 3n- Site WeLI ( s ) as o x umber & Type Irr I om I ub <br /> S core S I Score S Score <br /> istance 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 ondition R conditiori R ordition <br /> V . Site Feature Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample ( feet ) > 100 1 - 100 25 - 502 <br /> Fractures in subsurface ( applies to foothills or mountain areas ) i, None Unknown Dresent <br /> verage Annual Precipitation ( inches ) xxxx <10 9 10 - 25 xmxmx 25- 402 <br /> an-Made conduits which increase vertical migration <br /> f leachate ( i . e . , septic systems , water wells , ponds ) , Q None Unknown resent <br /> pique site features : Recharge area , coarse soil , or wells . At least ore than <br /> [MuncipaL => 2000 ft ; domestic=>500 ft ; irr/agricultural=present] �xxmx more /� one one <br /> COLUMN TOTALS>>> TOTAL POINTS N t� + 61, + a <br /> ample Result : ( BT X OR E ) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 <br /> 7K � rt , <br /> B r x E B r x E <br /> MAXIMUM ALLOWABLE B• T-X -E LEVELS ( PPM ) 1 50 50 50 .3 . 3 1 . 1 . NAl <br /> ample Result : ASOLINE 1000 100 I 10 <br /> .,x1 AXIMUM ALLOWABLE TPH LEVELS (PPM ) <br /> Iy D TPH - T) IESEL 10 , 000 1000 100 <br /> FOOTNOTES : *** If documented soil and/or ground water contamination is present , do not complete the ( Z king potenti <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 . , score 0 points . If depth <=5 ft . , do not use table. <br /> 2 If precipitation is > 40 inches , score 0 points . <br /> N3 Levels for BTX&E are not applicable at a TPN concentration of 10 ppm ( gasoline ) or 100 ppm (diesel ) . <br /> VI . STAFF RECOMMENDATION/CONCLUSION Ulf <br /> 1 . Are BTX & E or TPN Concentrations > Allowable Levels Yes 01 1 <br /> U� ;1bt`�-C. <br /> 2 . Recommend Site Closure es o If Yes , Refer to Site Mitigation for- Eval.uati.o - I P I- p <br /> VII . REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/LEAD SENIOR - -- --- - <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE Eno <br /> EFERRED TO SITE MITIGATION FOR EVALUATION ES O <br /> ATE REFERRED / �. ATE CLOSURE LETTER MAILED <br /> AME OF <br /> VALUATOR <br /> EH 23 80 ( UGTWKSHT ) \5/94 <br />