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• SAN JOAQUIN C(7UNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL ME" DIVISION r <br /> I� UGST WONKSHEET FOR SITE CLOSUKE EVALUATION ATE <br /> ANE OF FACILITY Me 7T H,/,► ,�Jy�/ ;yam - uEEPS CODE P��Ea'T, <br /> ( ORESS S� 1:3 4 � 5. A" W`-'�"•�� Y AHK 10 it <br /> LANK S12E j010 Ur� uEL TYPE �(G' �� �/PA , GA '7373-7d ' <br /> I. GENERAL SITE HISTORY •• <br /> Is permit current? es o ermit N - aeltity Status Code oc.Soil/GN Cont ea o <br /> umber of Tanks at facility go of Tanks(if available) Type of Tank tact brill ngt Dual <br /> Ill. TANK HISTORY <br /> as Tank testec? es o ailed precision test ? ea o If yea, give dates) <br /> Jas a repair node to the tank system] es No f yes, what was repaired? <br /> as repair done under Inspection? or. 40 ere soil samples analyzed7 es o ITXE PM-G PH-0 b/ED8 <br /> Type of failure/discharge atastrophlc It-ong-teraleakage verfill rwwn cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es o epth to Ground Nater (,-� of/Year verage Annual Precipitation ■ 4 0-25 <br /> -Site Well(s) es o umber L Type lrr on ub <br /> S core S core S core <br /> istance to Wells) from Tank L)ft; ft; ft C 0 pts C Pts G pts <br /> 0 it O if 0 if <br /> A -onditIon A ondition R ondition <br /> Site Feature - Leaching Potential Analysis E is mxK E is met E is net <br /> inisxss Depth to groundwater from the Soit Sample (feet) >100 G� 1-100 25-501 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> %verage Annual Precipitation (inches) xxxx 410 9 10-25 xxxxxx 26-4Q�2 <br /> on-Itade conduits which increase vertical migration Unknown resent 09 <br /> 1 leachate (i.e., <br /> septic syscaas, water wells, ponds) None <br /> iolue site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> �---� zxxx None one one <br /> COLUMN TOTALS),>>TOTAL POINTS i • • O •;�� <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS .9 pts or more 41 - 48 pts 40 Pts or less <br /> O I T I E B T X E <br /> MAXI" ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 SO .3 .3 1. 1. HAL <br /> ample Result: SOLINE 1000 100 10 <br /> IMUN ALLOWABLE TPH LEVELS (PPM) 100 <br /> TPN rj �p;Q/- IESEL 10,000 1000 <br /> OOINOTES: •••lf documented soil and/or ground water 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 /> 11 If depth is > 5 ft. and < 25 it., score 0 points. 1f depth <=5 ft., do not use table. <br /> 17 If precipitation is > 40 inches, score 0 points. <br /> 13 Levels for BTXLE are not applicable at a TPH concentration of 10 ppM (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION VP" <br /> • 1. Are BTX L E or TPN Concentrations > Allowable Levels Yes o 4q I <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Eva tion <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> \ F�ATE�REFERRED <br /> WITH STAFF RECOMMENDATION FOR CLOSURE ES EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE CLOSURE LETTER MAILED` <br /> VALUATOR <br /> fit 23 KO (UGTWKSHT)\5/90 <br />