Laserfiche WebLink
SAN JOAO COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL ALTH DIV" <br /> I 1' UGST WORKSHEET FOR SITE CLOSUREIEVALUATION <br /> ATE � . 16 FO <br /> ARE OF FACILITY LA u-e P Sc odds S ' <br /> i WEEPS CODE i vZ 3 <br /> DRESS l o o Co. Vim,L� <br /> AHK ID ;! I 've 323 <br /> ARK SIZE /01OQaG'AL UEL TYPE <br /> Ste(, <br /> It. GENERAL SITE HISTORY <br /> } <br /> Is permit current? es ** <br /> o x ermit p stili[ Status Code <br /> 2ksOE <br /> Y ocumber of Tanks at facility ge of Table) of Tank tee( Fbr t <br /> rH�� UNIS Ype g ngl Dval <br /> III. TANK HISTORY <br /> as Tank tested? es o aile4precision test? es N/q, o If es, <br /> Y give date(s) <br /> as a repair made to the tank system? Mo x f yes, what was repaired?as repair done under inspection? es ere soil samples analyzed? eso TxE PH-G PH-p 6/EDB <br /> ype of f8llure/discharge atastropfang-term leakage verfil!'k. known [her: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA 'F C N POTENTIAL ANALYSIS) <br /> 1 <br /> Soil Samples Received es X o epth to Ground Water lip 4 of/Year verage Arcual Precipitation = 4 0 25 t <br /> -Site Wells) es a umber 8 type �, . Irr am ub <br /> istance to Wells) from Tank /010 ft; ft; S core S core S core <br /> ft C 0 pts C 9 pts C pts <br /> 0 if - 0 if 0 "f <br /> Rondition R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is filet E is met E s met <br /> inimum Depth to groundwater from the Soil Safiple (feet) X100 1-100 25-501 <br /> ractures In subsurface (applies to foothills or mountain areas) lb <br /> None. - Unknown resent <br /> verage Annual Precipitation (Inches) xxxxx <10 9 10-25 xxxxxxx 26-40)_2 <br /> Ion-Made conduits which increase vertical migration , # <br /> f leachate (i.e., septic systems, water wells, Ponds) None Unknown tresent <br /> Igoe site features: Recharge area, coarse soil, nearby wells. At least r ore than <br /> xxxxx None one .� one } <br /> COLUMN TOTALS»>TOTAL POINTS /Q + + Z -! <br /> ample Result: (B T X OR E) ]RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or,less --, _. <br /> B T X E B JT: IX E <br /> MAXIMA] ALLOWABLE B-T-X-E LEVELS(PPM) 1 50 50 50 .3 .3 1. 1. NAL <br /> Sample Result: ASOLINE 1000 100 10 , <br /> IMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESEL 10,000 1000 100 <br /> oOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> analysis. (i.e.; site is turrently on UGT Contamination List for soil or ground water.) <br /> < <br /> _\1 if depth is > 5 ft. and < 25 ft., score 0 points. If depth _5 ft., do not use table. <br /> J2 if precipitation is > 40 inches, score 0 points. <br /> L Levels for BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION y a <br /> I <br /> 1. Are BTX S E or TPN Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure es o If Yes, Refer to.Site Mitigation for Evaluation <br /> Vt?. REVIEW EVALUATION - TO 8E COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES' a EFERRED TO SITE MITIGATION FOREVALUATION fES 0 <br /> ATE REFERRED / / ATE CLOSURE LET•TER.MAILED <br /> AHE OF <br /> :VALUATOR <br /> EH 23 BO (UGTWKSHT)\5/90 <br /> I <br />