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SAID JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITY/TANK INFORMATION DATE: 1 5/5/16 SITE/FACILITY NAME: CCJ&S LLC vacantproperty) STATUS CODE: ADDRESS: 1825 E. Dr. Martin Luther King,Jr. Blvd. CITY: I Stockton FA#: 0023354 PR# :0540852 TANK# 0520797 TANK SIZE: 550 gallons FUEL TYPE: unknown Il. GENERAL SITE HISTORY Is Permit Current? 0 Yes ❑ No ❑n/a Documented Soil/GW Contamination?*** ❑ Yes d No Number of Tanks at Facility 1 Age of Tanks(if available) unknown Type of Tank OSteel ❑Fiberglass ❑Single ❑Dual III. TANK HISTORY Was Tank Tested? ❑ Yes 0 No Failed Testing? ❑ Yes ❑ No 0 n/a If Yes, Provide Dates: n/a Was Tank System Repaired? ❑Yes❑No 0 n/a If Yes, Describe Repair: 0 n/a ❑ BTEX 0 TPH-G 0 TPH-D ❑ LEAD Was Repair Done Under Permit? ❑Yes❑No On/a Were Soil Samples Analyzed? 0 Yes ❑ No ❑ EDB 0 OTHER VOCs, Semi-VOCs, T22 Metals, PCB,Oil&Grease Type of Failure/Discharge: ❑ Catastrophic ❑ Long-term Leak ❑ Overfill 0 Unknown ❑ Other IV. REMOVAL HISTORY(Attach File) Soil Samples Received? 0 Yes ❑ No Seasonal High Depth to GW 50 ft bgs Year/Reference Spring 1997 Onsite and/or Nearby Well(s)? ❑Yes 0 No LJ Irrigation: # Distance to Tank ft � Score 10 C Score 9 C ❑ Domestic:# Distance to Tank ftO points if 0 points if 0 Score 5 points if L3Public: # Distance to Tank ft R condition is R condition is R condition is met V. SITE FEATURE—LEACHING POTENTIAL ANALYSIS E met E met E Minimum Depth to Groundwater from Soil Sample(feet) >100 51 —100 5 25-501 Fractures in Subsurface(applies to foothill or mountain areas) 10 None Unknown Present Average Annual Precipitation(14 inches for SJC area) -------- <10 9 10-25 -------- 26-402 Man-Made Conduits which Increase Vertical Migration None 9 Unknown Present i.e.septic sstems,water wells, ponds) Unique Site Features: Recharge Area, Coarse Soil(coarse sands, 10 None At Least One More Than One gravels),nearby wells Column Totals Total Points 20 + 18 + 5 = 43 Sample Results for BTEX: Range of Total Points 49 Points or More 41 —48 Points 40 Points or Less Maximum Allowable BTEX B T E X B T E X N/A3 Levels ppm 1.0 50 50 1 50 0.3 0.3 1.0 1.0 Sample Results for TPH: Maximum Gasoline 1,000 100 10 Allowable TPH Levels ppm Diesel 10,000 1,000 100 Footnotes: ***If documented soil and/or groundwater contamination is present,do not complete leaching potential analysis(i.e.site is already on the contamination list). 1 If depth is>5 feet and<25 feet,score 0 points. If depth is-5 feet,do not use table. 2 If precipitation is>40 inches,score 0 points. 3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. VI. STAFF RECOMMENDATION/REFERRAL/REVIEW 1. Are BTEX or TPH Concentrations>Allowable Levels? ❑Yes 0 No 2. If No, Is Site Closure Recommended? 0 Yes ❑ No Completed By: Stacy River Date Referred to Site Mitigation Unit for Final Actiont 5/5/16 Reviewed By: �� Concur with Staff Recommendation es ❑ No Date Closure Letter Mailed tAll Cases are Referred to Site Mitigation for Final Action EH 23-0080(Rev 11/14/08)