Laserfiche WebLink
E <br /> L ; <br /> SAN JOACUIP 1UNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL ! H OIVISICN <br /> �`UGST WORKSHEET FOR SITE G OSURE FVALUATiON`���► jDATE� <br /> !NAME OF FACILITY fs�� J J' �_ �� ,��c" SWEEPS C^aE <br /> ADDRESS! .�:% r/ j � ti� I TANK ID »? <br /> f <br /> j TANK SIZE+ / � r. �FUEL "YPE <br /> i 11. GENERAL SITE HISTORY <br /> -'INhol Perini: n - !Facility Status Code �f-loc.Soil/GW Cont;Yes: �Noi <br /> i's aermiz current? Yesi <br /> !Number of Tanks at facility{ !Age of Tanks(if availabie)I,rl ��{Type of Tankjsteet;�1 Fbrgi! ISngL� Dualij ! <br /> ii TII_ TANK HISTORY <br /> I` !Was Tank tested?.iYes No iFaited precision test ? YesINo! IIf yes, give date(s)I %7 -7 <br /> l <br /> 1A <br /> !Was a repair made to the tank system?lyes! Na �rTf yes, what was repaired?i <br /> I � <br /> Was repair done under inspection?�Yes l �No were so il-samotes analyzed?;Yes! INoi BTXEi ;TPH-GI TPH-DI IPb/EDfi� <br /> iTYpe of failure/discharge icatastrophicl Long-term leakage ioverfiL€l }unknown cher: <br /> IV. REMOVAL HISTORY (ATTACH !NSP=_ ION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> (Soil Samples Receivedlyes!,ANo! (Depth to Ground Water , ' Ref/Year !Average AnnuaL Precipitation A=" <br /> 14 110-25'I <br /> II I I <br /> 10n-Site Well(s)IYes Igo 3Numb er & Type i Ird !Dam! 1pubi <br /> S ScareI S Score 5 (Score <br /> i <br /> Distance to Wetl(s) from Tank ft; ft C 10 pts 1 C 9 pts 115 pts <br /> 0 {if 1 0 if i 0 if <br /> R !condition R car+dition R condition <br /> V. Site Feature - Leaching Parentiat Analysis E is met E c is met E is met <br /> _ I 1 �. <br /> . !Minimum Death to groundwater frim the Soil Sample'(fep..�) .100 151-100 2;-50\1 <br /> !Fractures in subsurface (applies to foothills or mountain areas) I�r None ! ' Unknown !Present <br /> (Average Annual Precipitation (inches) lxxxxxx� <10 1 9 ! 10-25 �xxxxxxXI 25-40\2 <br /> ?Man-!lade conduits which increase verticat migration i <br /> 4 <br /> jof Leachate (i.e.., septic systems, ,water wefts, ponds) �, None I unknown I (Present <br /> Unique site features: Recharge area, coarse soil, nearby wells. At Least! iMors than i <br /> j <br /> jxxxxxxj None I one! I one <br /> . <br /> jCOLUMN IOTALS>»TOTAL POINTS <br /> I <br /> Sample Result: (3 T X OR -c) RANGE OF TOTAL POINTS149 pts or more I' 41 - 48 pts I 40 pts or less t <br /> e r 1 X 1 E 3 I r x E I <br /> EC j MAXIMUM ALLOWABLE B'T-X-E LEVELS {PPM) 11 5011 50� 50 .3 1.3 I i.l 1. 1 NA\'J 1 <br /> Sampte Result- GASOLINE 1000 100 10 <br /> "i <br /> MAX IMIM ALLOWABLE TPH LEVELS (PPM) <br /> 5 7 o TPH_o iDIESEL 10,000 1000 100 <br /> FCOTNOTE5: *"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 /> ! \1 If depth is > 5 ft. and < 25 ft., scare 0 points. If <br /> depth <xS ft., da not use table. - <br /> \2 If precipitation is > 40 inches, score 0 points. + <br /> \3 Levets for 3TX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> l 1. Are BTX & E or TPH Concentrations > Atlowable Levels I*Yesl Nol <br /> 2. Recommend Site CtosurelYesl No{ whams, Refer to Site Mitigation for EvaLuation <br /> VII. REVIEW 'EVALUATION - TO BE COMPLETED 3Y A SU <br /> kPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECAMMENDATION FOR CLOSURE{YES! IN01 REFERRED TO SITE MITIGATION FOR EVALUATIONjY=-St ;NO1 <br /> !DATE REFERRED] / / DATE CLOSURE LETTER MAILEDI <br /> F � I <br /> !NAME OF <br /> EVALUATOR <br /> 23 80 (UGTWKSHT)\7/90 <br />