REMOVAL_2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION $ R � I . FACILITYITANK INFORMATION DATE : — SITE/FACILITY NAME : A lLuLd ( Vl STATUS CODE : ADDRESS : NAM; � • -Darmc( O st ' CITY: � I Dcuo FA#: I PR#: TANK # j 39 .1, 0 k 09 TANK SIZE : SOO FUEL TYPE : l� 1'1 . NOt� II . GENERAL SITE HISTORY Is Permit Current? ❑ Yes ❑ No NA Documented Soil/GW Contamination ?*** ❑ Yes No Number of Tanks at Facility I Age of Tanks (if available) WA ❑ pe of Tank teel ❑ Fiberglass IRSingle Dual III , TANK HISTORY Was Tank Tested ? ❑Yes ❑ No XNA Failed Testing? ❑ Yes ❑ No IRNA If Yes , Provide Dates : Was Tank System Repaired? ❑ Yes ❑ No (NA If Yes , Describe Repair : Was Repair Done Under Permit? ❑ Yes L3No,dNA Were Soil Samples Analyzed ? LJYes LJNo ❑ BTEX L3 TPH-G ❑ TPH -D ❑ LEAD ❑ EDB ❑ OTHER ❑ OXYGENATES Type of Failure/Discharge : ❑ Catastrophic ❑ Long-term Leak ❑ Overfill Unknown ❑ Other IV, REMOVAL HISTORY Attach File Soil Samples Received ? XYes ❑ No Seasonal High Depth to GW ft bgs Year/ Reference Onsite and/or Nearby Well (s) ? O Yes o Ll Irrigation : # Distance to Tank ft � Score 10 C Score 9 C ❑ Domestic: # Distance to Tank ft 0 points if 0 points if 0 Score 5 points if ❑ Public: # Distance to Tank ft R condition is R condition is R condition is met V. SITE FEATURE — LEACHING POTENTIAL ANALYSIS E met E met E Minimum Depth to Groundwater from Soil Sample (feet) > 100 51 - 100 `7 25 501 Fractures in Subsurface ( applies to foothill or mountain areas) None 9 Unknown Present Average Annual Precipitation ( 14 inches for SJC area) < 10 9 10 - 25 26 - 402 Man - Made Conduits which Increase Vertical Migration None G! Unknown Present i . e . septic sstems , water wells , ponds) Unique Site Features : Recharge Area, Coarse Soil (coarse sands , 10 rn None At Least One -- More Than One gravels) , nearbywells V Column Totals Total Points 10 + a + _ Sample Results for BTEX: / Range of Total Points 49 Points or More 41 — 48 Points 40 Points or Less E T — < Z, I ( Maximum Allowable BTEX B T E X B T X N/A3 E - L. 2• ( CNJ7 Levels (ppm) 1 . 0 50 50 50 0 . 3 0 . 3 0 1 . 0 X 2 LLQ IT44 0yo ) Sample Rest4s f PH : Maximum Gasoline 1 , 000 100 10 Allowable TPH Levels m Diesel 10, 000 11000 100 Footnotes: *** If documented soil and/or groundwater contamination is present, do not complete leaching potential analysis ( i.e. site is already on the contamination list). 1 If depth is >5 feet and < 25 feet, score 0 points. If depth is <=5 feet, do not use table. 2 If precipitation is > 40 inches, score 0 p ints . l ' ` 3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel . — 8 2`1 frig Wq VI . STAFF RECOMMENDATION/ REFERRAL/ REVIEW I a v 1 . Are BTEX or TPH Concentrations > Allowable Levels? j,Yes No 2 . If No, Is Site Closure Recommended ? ❑ Yes No � Q Completed By: Date Referred to Site Mitigation Unit for Final Actiont Reviewed By : Concur with Staff Recommendation ❑ Yes ❑ No II Date Closure Letter Mailed tAll Cases are Referred to Site Mitigation for Final Action I EF123 -0080 (Rev 11 / 14/08)