Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICESIENVIRUMENIAL HEALza UV( zivn <br /> WORKSHEET FOR SITE CLOSURE EVALUATION D <br /> J�� l <br /> NAME OF FACILITY � SPS CODE O <br /> / TANK IO 2 <br /> ADDRESS �q'd,Jr 60.1(C 4.ed, Com' 3.7 231{(e C) !-- 0;k, <br /> TAMC SIZE /v vn FUEL TYPE uK1e&dtc1 as 7"� � <br /> . <br /> i <br /> it. GEMERAL SITE HISTORY <br /> Is permit current? Yes No Permit it - Facility Status Code. Doc.Soitl� Cont les No <br /> Murber of Tanks at facility Ageof Tanks(if available) Type of Tank Steel brgl- Sngl Oval <br /> IIE. TANK HISTORY <br /> Was Tank tested? Tea No Fasted precision test flusNo if yet, give date(s) <br /> Was a repair made to the tank system? Yes Noit yes, whet was repaired? <br /> Was repair done under inspection? Yes No here soft samptes analyzed? Yes Ifo 81X1 TPH-G TPN-D ! <br /> Type of failure/discharge catastrophic tong-tern leakage overfill unknown other: J (� <br /> IV. REMOVAL HISTORY (ATTACH INSAE CON REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) r.1 <br /> Soil Saaptes Received Yes Na Depth to around water 3U' Ref/Year.1. ��, Average Arcual Precipitation A■ 1 �-4 <br /> On-Site Welt(s) Yes NoNumCer i Type Irr Dam Pub <br /> S Score S Scare S Scol i <br /> Distance to Welts) from Tank ft; ft; ft C 10 pts C 9 pts C 5 P+ Za <br /> o if 0 if O if V� <br /> R condition R condition R con t� <br /> V. Site Feature - Leaching Potential Analysis ^� E is met :E is met E is i, <br /> t Minimus Depth to groundwater from the Soit Sample (feet) `3 d ��b �` J >100 51-1e0 0 25-50\1 <br /> Fractures in subsurface (applies to foothills or mourstafn a s) lye None Unknown Present <br />` Average Annual Precipitation (inches) xxxxxx s10 9 110-25 x=xxxx 26-40\2 <br /> Man-Nade conduits whish increase vertical migration <br /> of teachate (i.e., septic systems, water watts, porde) None �` Unknown Present <br /> Unique site features: Recharge area; coarse soil, nearby watts. At least flare than <br /> xxxxxx None one one <br /> C0 UMS TOTALS»>TOTAL POINTS <br /> Sample Result: (3 T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 43 pts or <br /> —a <br /> 1(r <br /> jVk4j MAXIfUM ALLOVABIE 9-T-X-E LEVELS (Piafl} t; 5C 50 50 .3 .3 1. 1. 101\3 <br /> k Sample Result: GASOLINE 1000 100 SO <br /> 3 KAXIMUN ALLMMLE TAN LEVELS (PPM) <br /> � toll -G DIESEL 10,000 1000 _ ' 100 <br /> FOOTNOTES: ***!f documented soil ardor ground water contamination 'is present, do not complete the Leaching po ant al <br /> analysis. (i.e., site is currently an UCT Contamination List for soil or grou crater.) <br /> i. \1 If depth is > 5,ft. and s 25 ft., score 0 points. If depth a5 ft., do not use tabta. <br /> \2 If precipitation is P 40 inches, score 0 points. <br /> \3 Levels for BTXhE are not applicable at a TPI concentration of 10 ppm (gasoline) or 100�ppn Cdteset). <br /> VI. STAFF RECOMMENDATION/CONCLUSION 1-ku C y 4tC-SC'&kA. 34 <br /> 1. Are BTX & Ear TPN Concentrations > ALL, to Levels *Yes Ho s 6ra'Ulrii�^�� u�" <br /> (/ 1 LYS• <br /> 2. Reca¢merd Site Closure Yes No If Yrs, Refer to Site Mitigation for Evaluation <br /> i VII. REVIEW EVALUATION - TO BE COMPLETED BY A:SUPERVI50R SENIOR <br /> CONCSR WITH STAFF RECCfiMENDAMN FOR CLOSURE YES V NO REFERRED TO SITE MITIGATION'FOR EVALUATION YES NO <br /> t DATE REFERRED / ! DATE CLOSURE LETTER NAILED / J <br /> NAME -F <br /> EVAL'.ATCR 1 <br /> EH 23 a0 (UGTWKSHT)\5/90 <br /> . .. ............... - _� ., <br />