Laserfiche WebLink
b,� �ir�(ver(-h z4. a✓� (�-r 1�' �c�.�-L�C ��J <br /> SAH d0A0U 4TY PUBLIC HEALTH SERVICES/E IRONMENTAL .m DIVISION <br /> 1. - UGST WORKSHEET FOR SITE CLOS E EVALUATION - <br /> AT <br /> 8E OF FACILITY 0414b,-ALCA- SWEEPS CODE q�-Z <br /> DORESS 130 W, a5 kC fVyl TANK 10 # <br /> AHK SIZE 15Q L)o UEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> ** <br /> Is permit current? es o rmit # lFacitity Status Code vim- 1 oc.Soit/GW Cont iYes o <br /> umber of Tanks at facility kge of Tanks(if available) f Tank Leel brgl ngl Oval <br /> ype o <br /> III. TANK HISTORY rem lel c cl V D <br /> as Tank tested? es o ailed precision test ? es aIf yes, give date(s) <br /> as a repair made to the tank system? IYes No 1 11f yes, what was epaired? <br /> as repair done under inspection? eso21119-term <br /> ere soil samples ana yzed? es TXE H-G -D ED[I <br /> ype of faiture/discharge atastrophic Leakage ver ill noun ther: <br /> 14 <br /> IV, REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> .oil Samples Received eso epth to Ground Water fD of/Yea in verage An uat Precipitation va 4 10-25 <br /> Dri-Site wett(s) es o umber & Type Irr am b <br /> S Score S Score 5 Score <br /> istance to well(s) from Tank ft; ft; ft C 10 pts C 9 pts C i pts <br /> 0 if 0 if 0 if <br /> R onditfon R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Sail Sarrpte (feet) >100 1-100 0 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Amuat Precipitation (inches) xxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase verticat migration <br /> f Leachate (i.e., septic systems, water wells, ponds) None Unknown 5 resent <br /> inique site features: Recharge area, coarse Boit, nearby wells. At Leas[ 4ore than <br /> xxxx None one one <br /> I3� �' gp W1PlQ� C0((@Cj8OLUMN TOTALS>>>TOTAL POINTS r 2- •j Z <br /> ampte Resutt: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 ptS 40 pts or Less <br /> $ 9a tJD@ 6ppb <br /> DOS$'ppw. G i X E B X E•011RYJ)mMAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 J.T <br /> 3 1- 1, NA\3 <br /> 'ample Result: ASOLiHE 1000 100 10 <br /> [per- AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> @ TPH IESEL 10,000 1000 100 <br /> FOOTNOTES: ***tf documented sail and/or ground water contaminate n is present, do not complete the Leaching potentia[ <br /> analysis. (i.e., site is currently on UGT Ccntarnination List for soil or ground water.) <br /> \I If depth is > 5 ft, and < 25 ft., score 0 points. f depth <-5 ft., do not use table_ <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for STX&E are not applicable at a TPH concentration of 10 ppm (gaso(ine) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION S'rj4mP� 00(oC ppro xY <br /> 1, Are BTX & E or TPH Concentrations > Altowable Levels Yes <br /> 2. Recommend Site Ctosure IYes o v,"' If Yes, Refer to Site Mi igation for Evaluation <br /> v11. REVIEW EVALUATION - TO BE COMPLETED SY A SUPERVISOR/SENIOR <br /> -ONCUR WITH STAFF RECOMMENDATICN FOR CLOSURE ES O EFERRED TO SITE MITIGATION FCR EVALUATION �ES ' 4 <br /> 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF <br /> _VALUATOR <br /> EN 23 30 (UGTWKSHT)\5/90 <br /> HH 29 80 <br />