Laserfiche WebLink
SAN JOAQUINY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEADDIVISION <br /> NAME OF FACILITY <br /> I• .,ST WORKSHEET FOR SITE CLOSURE EVALUATION DATE0 <br /> �,h� J 72 ice/Y I SWEEPS CODE <br /> ADDRESS f-jd4jy <br /> TANK SIZE FUEL TYPE �// _ oil <br /> w� f <br /> 11. GENERAL SITE HISTORY <br /> Is permit current? Yes No Permit # - Facility Status Code rj v l Doc *** <br /> Cont CoYes No <br /> Number of Tanks at facility Age of Tanks(if available) Type of Tank Steel Fbrgl Sngl Dual <br /> 1II. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test ? Yes No K If yes, give dates) <br /> Was a repair made to the tank system? Yes No >qlf yes, what was repaired? <br /> Was repair done under inspection? Yes X Nojton <br /> !te,!- 17eakage <br /> s analyzed? Yes X No BTXE k TPN-G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic overfill unknown other: <br />--,"'V. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes x No Depth to Ground Water /Year Average Annual Precipitation A= 14 10-25 <br /> On-Site Well(s) Yes No Number, & Type Irr Dom Pub , <br /> Distance to Wells) from Tank ft; ft; S Score S Score S Score <br /> ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water wells, ponds) None Unknown Present <br /> iUnique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS + + - <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more •41 - 48 pts 40 pts or less <br /> b B T X E B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 <br /> © MAXIM6M ALLOWABLE TPH LEVELS (PPM) <br /> TPH,-+ DIESEL 10,000 1000 100 <br /> FOOTNOTES:jS ***If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> me 4-o analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br /> A .. IV-..✓ \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table.- <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> '�''r,�// \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels *Yes No <br /> 2. Recommend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation <br /> I. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR,,WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />