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SAN JOAOUIH CCUNTY "W HEALTH SERVICES/ENVIRONMENTAL HEALTH OIVISIN DATE <br /> UGS1 >t :T FOR SITE CLOSURE EVALUATION �-- <br /> SWEEPS C90E 6 7 <br /> INANE OF FACILITY, ,Mt1►- /►,.,��,�'— v <br /> AOORfSSI �TfJg•C /�/�/�[ rv�'" � �I�- �i"%OG-fr�D/�� TANK IO 4 74/- <br /> TANK SIZE !{,DU�� FUEL TYPE v/��' <br /> II. GENERAL SITE HISTORY ••• <br /> is permit current? Yes No Permit B <br /> Facility Status Code Ooc.SoiUGW Cont Yes No <br /> Hurber of Tanks at facility Age of TanksO f avail�a}ble) Type of Tank Steal Fbrgl 1SngL1 Dual <br /> III. TANK HISTORY JDj � r <br /> Was Tank tested? Yes He Failed precision test 1' Yes No If has, <br /> / I <br /> Was a repair made to the tank system? Yes No If yes, what was repaired? <br /> IWas repair done under inspection? Yes We Were soil saaples analyzed? Yes No BTXE TPH-G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic {long-term leakage overfill unknown other: <br /> IV. REKCVAt HISTORY (ATTACH INSPECTION REPORT FCA SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSES) <br /> Soil Samples Received Yes Me Depth to Groisd Water yid Ref/Year �� ; <br /> Average Anmal Precipitation A= 14 10-25 <br /> Pub�c <br /> on-Site Well(s) Yes No Number b Typo Irr DOM � S Score S Score S Score <br /> ft C 10 pts C 9 pts C 5 pts <br /> Oistanr_ to WeLtCs} from Tank "` ft: ft% 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Si:e Feature - teaching Potential Analysis <br /> E is mat E is csttt E is ext <br /> Minimum Depth to groundwater from the Soil Semple (feet) �Z 7v UT� <br /> >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) <br /> None Unknown <br /> � Present <br /> xxu <10 9 10-25 XXXXXXX 26-40\2 <br /> Average Annual Precipitation (inches) <br /> I ` � <br /> Man-Made conduits which increase vertical migration None If U wn Present <br /> of Leachate (i.e., septic systems, water wells, ponds) <br /> I At Least Mora than <br /> Unique site features: Recharge area, coarse soil, nearby walls. xxxxxX None one one <br /> COLUMN TOTALS»>TOTAL POINTS <br /> Sample Result: (3 T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 4a pts <br /> I 40 pts or less <br /> a' ooZ N �4 P��A B T X E B JT X E <br /> ?:.ooZ � NA\3 <br /> k' '�o= P&^ MAXItS1A9 ALLOWABLE B-T•X-E LEVELS CPPM) 1 50 50 50 .3 .3 1• 1 <br /> GASOLINE 1000 100 10 <br /> Sample Result�OZ <br /> ' �i`N MAXIKUH ALLOWABLE TPH LEVELS (PPM)roIESEL 10,000 1000 100 <br /> ! �0 TPH -hin <br /> FOOTNOTES: *•'If doccsnenana`ysis. (i�Osite°is currentld water y UGTtion to ContaminationtList or Smet alt or grPLOtO h�aar <br /> waterr9.)�tantial <br /> \1 If depth is > 5 ft. end < 25 ft., score 0 points. If depth 4:5 ft., do not use tablo. <br /> \2 Ef precipitation is > 40 inches, score 0 points. <br /> \3 levels for 3TXLE are not applicabla at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECCMMENDATION/CONCLUSIOH <br /> 1. Are 3TX I E or TPN Concentrations > Allowabla Levels *Yes Mo <br /> 2. Recommend Sita Closure Yes No if -fag, Refer to Site Mitigation for Evaluation �j T� <br /> VII. REVIEW EVALUATIC14 - TO 3E CCMPLETED 3Y A SUPERVISOR/SENIOR iIJ 11 <br /> F9zrrrl� <br /> N FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EYALUATECd TES NO <br /> 9 DATE CLOSURE LETTER MAILED <br /> EH 23 30 (UGTWKSHT)\5/90 <br />