Laserfiche WebLink
^rr <br /> 1 <br /> SAN JOAL COUNTY PUBLIC HEALTH SERVICES/ENVIRONMEN" ..cALTH DIVISION <br /> 1• UGST WORKSHEET FOR SITE CLOSURE EVALUti ATE _jv(,tt �c�q <br /> AME OF FACILITY i O� S.��K-�� L-3 I LCA F—ZGI SWEEPS CODE 1�$ <br /> DRESS Z22— <br /> TANK ID # <br /> ANK SIZE lo, <br /> Coo UEL TYPE �1twy� <br /> It. GENERAL SITE HISTORY <br /> Is permit current T es o ermit # - acidity Status Code oc.Soit/GW Cont es o <br /> umber of Tanks at facility ?� ge of Tanks(if available) 7ype of Tank feel IF brgl ngl Dual <br /> 111. TANK HISTORY <br /> Jas Tank tested? as o ailed precision test ? es o f yes, give date(s) <br /> Jas a repair made to the tank system? 1Yes No f yes, what was repaired? <br /> Jas repair done under inspection? as NI <br /> pmr <br /> ere soil samples analyzed? es TXE G -D b/EDBype of failure/discharge atastrophicterm leakage verfill nown er: <br /> IV. REMOVAL HISTORY (ATTACH INSPECT ON REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es o epth to Ground Water a0 of/Year !�"' ;19g& verage Annual Precipitation = 4 0-25 <br /> -Site Wells) es I u+I umber & Typelrr am ub <br /> 1 _IS core S core S core <br /> istance to Welt(s) from Tank _LQ_ft; ft; ft C 0 pts C 9 pts C pts <br /> 0 if 0 if 0 if <br /> R ondition R condition R ondition <br /> 1. Site Feature - Leaching Potential Analysis E is met E is met E s met <br /> inimum Depth to groundwater from the Soil Sample (feet)�D'�Ocd ���> >1001-100 O 25-5011 <br /> ractures in subsurface (applies to foothills or mountain areas) None -1 Unknown Present <br /> verage Annual Precipitation (inches) xxxx <10 9 10-25 xxxxxxx 26-4012 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown 'resent, <br /> nique site features: Recharge area, coarse soil, nearby welts. At least 4ore than <br /> xxxx None •� one one <br /> COLUMN TOTALS»-TOTAL POINTS i Z T-- t �Z <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> ppm <br /> B 1 T X E B X EMAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 SO 50 .3 I.T <br /> 3 1. E NA13 <br /> Sample Result: rIESEL <br /> E 1000 100 10 <br /> g�0•� TPH IMUM ALLOWABLE TPH LEVELS (PPM) <br /> 10,000 1000 100 <br /> OOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the teaching 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 ft., score 0 points. if depth <=5 ft., do not use table. <br /> 12 If precipitation is > 40 inches, score 0 points. <br /> 13 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> I. Are BTX & E or TPN Concentrations - Allowable Levels Yes o <br /> 2. Recommend Site Closure es o if Yes, Refer to Site Mitigation for Evacuation <br /> V11. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / 9 / 9 J ATE CLOSURE LETTER MAILED <br /> AME OF <br /> VALUATOR L v- <br /> EH 23 80 (UGTWKSHT)\5/00 <br />