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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> 1. ' WORKONEET FOR SITE CLOSURE EVALUATION DATE _ 7 �j3 <br /> NAME OF FACILITY SWEEPS`� J <br /> aOoaESS �/D D tJ !- i TANK tO 0 - <br /> TANK SIZE FUEL TYPE u)Ct <br /> I1. GENERAL SITE HISTORY <br /> rrr <br /> Is permit current? Yes No Permit # - Facility Status Code Doc.Soil/GW Cont Yes No <br /> Number of Tanks at facility Age of Tanks(if available) Type of Tank Steel Fbrgl Sngl at <br /> III. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test ? Yes No If yes, give dates) <br /> Was a repair made to the tank system? Yes No If yes, what was repaired? <br /> Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE TPH-G TPH-0 Pb/EDB <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water (3 Ref/Year ��j; Average Annual Precipitation As 14 10-25 <br /> On-Site Welt(s) Yes No Number i Type Irr Dom Pub <br /> S Score S Score S Score <br /> Distance to Wells) from Tank 2'j—ft; ft; 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 - Leeching Potential Analysis E is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet)5c)-- 9=14,." >100 51-100 15 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) J b 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 57 Present <br /> unique site features: Recharge area, coarse soil, nearby wells. n At least More than <br /> xxxxxx None r one one <br /> COLUMN TOTALS>>>TOTAL POINTS 1 O + X + / 6) _ <br /> Samptriiae�l 'TX OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> tMAXI:" <br /> B T X E B T X E <br /> -(bb I�tqIt, .4 + 3 ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: K GASOLINE 1000 100 10 <br /> rr N� " �i•45 '^�` � MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> -TP14 :-.13P2PH DIESEL 10,000 1000 100 <br /> FOOTNOTES: *If documented soil and/or ground water contamination is present, do not complete the leaching 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., score 0 points. If depth —5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX3E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> Vi. STAFF RECOMMENDATION/CONCLUSION ��� >7'e"a�`/ fi6V _<k*Gid C� <br /> 1. Are BTX A E or TPH Concentrations 3, Allowable Levels *Yes No P/iYGLris�ct <br /> 2, Recommend Site Closure Yes No If Yes, Refer to Site Nitigation for Evaluation � 4,Ey►1�wvw p Jv IG��C, <br /> VIf. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE TES NO REFERRED TO SITE MITIGATION FOR EVALUATION TES NO <br /> DATE REFERRED / / DATE CLOSURE LETTER NAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />