Laserfiche WebLink
SAN JOAOI): COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> I' UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> 7- 90 <br /> AME OF FACILITY _ ��j� % # a�5 WEEPS CODE <br /> G Z- 7-77� <br /> DRESS C2 / �! `�CG� ANK bD,# 3� - / ! /'�? <br /> ANK SIZE 77 } UEL TYPE (J <br /> 11. GENERAL SITE HISTORY <br /> 41speram,'if current? es o ermit # - acility Status Code y�/ oc.Soi /GW Cont esr Tanks at facility ge of Tanks(if available) Gt:y� ype of Tank/ reel Fbrgl NL Dual <br /> III. TANK HISTORY <br /> as Tank tested? es ✓ o ailed precision test/? es o I if yes, give date(s) 7 //5 /Jf <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> Jas repair done under inspection? es o L� ere soil samples analyzedl es o TXE PH-G I PH-D I 1Pb/EDB <br /> ype of failure/dischargeatastrophic long-term leakage verfiLL nknown cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> ristance <br /> l Samples Received es o epth to Ground Water of/Year verage Annual Precipitation = 4 0-25 <br /> Site Wells) es o umber 8 Type Irr om ub <br /> S core S core S core <br /> to Wells) from Tank ft; ft; ft C 0 pts C pts C pts <br /> 0 if 0 if 0 f <br /> V. R ondition R ondition R ordition <br /> Site Feature - Leaching Potential Analysis ('i�t�p E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1-100 25 501 <br /> -� <br /> Fractures in subsurface (applies to foothills or mountain areas) I C) None Unknown resent <br /> verage Annual Precipitation (inches) xxxxx <10 9 10 25 xxxxxx 26 40�2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None C Unknown resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS G + <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> 1 X= O, t <br /> T l-U, //nn B T x E B T X E <br /> `4, / MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA13 <br /> Sample Result: _ ASOIINE 1000 100 10 <br /> AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> t-42 /3 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 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 /> L Levels for BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPH Concentrations > Allowabe Levels Yes off` pc <br /> 2. Reconend Site Closure es o If Yes, Refer to Site Mitigation for EvaluationL-CVII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> p <br /> m <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE fES 0 EFERRED TO SITE MITIGATION FOR EVALUATION fES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF <br /> VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />