Laserfiche WebLink
SAN JOAQ IN CPUBLIC HEALTH SERV CESVERV N'TAL IfEALliwAvIslow <br /> I II ST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AMI CF FACILITYEPS COOJE <br /> ORE ANK 10 # <br /> ANK SIE r ui TYPE �# <br /> 11, GENERAL SITE HISTORY <br /> i ri tSrrPSt e i l fl SatCl i$ Cent os 0 <br /> r of Ta k at fa it ty Se kst avast ble) Tank teel brgl ngt Dal <br /> 111. TANK HISTORY <br /> 'as Tank rest as 0 all pre isi test T st If s gi a date s) t T <br /> as a repair made to the tank syst <br /> no repair dome urder inspection? a TXE PH.0 PH-0 CS <br /> V raf faiEcaredi terga atastr"�pic t R�!;re laakae �erftl thr� <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING P TENTiAL ANALYSIS) <br /> oil Sallotes it rage Annual Precipitation A to- S <br /> -Sire itett(s r yt Trr <br /> care S core S care <br /> istanot to welEts) r Tam f rt ft C C pts C; pts C pre <br /> f C If C <br /> R andition R onditionR ondition <br /> Site Feature < Leschims Potential Analysis E is met E'- is met E t <br /> imimun Cepth to groundwater'from the Sail Sarr to ;((feet) >100 1-100S St11 <br /> ractur s In subsurface (applies to foothilts or mountain areas) �° None urs ntr r est <br /> Ivcrage Annual Precipitation (inches) xxxxx <10 9 10# 5 KXXXXXX -4 \ <br /> am*Mada condifts which ir4resse vertical migration <br /> f teachate (i.e., septic systems, ) Ne nk resent <br /> pater yells, <br /> Ini re arta features: Recharge area, coarse soil, nearby welts. At 'least ore than <br /> xxxxx N e one <br /> COLUMN TOTALS—TOTAL POINTS: + <br /> amptt Result: IS T X OR E RANGE OF:TOTAL POINTS 9 pts or more 41 48 pts 40 pts or leas <br /> S T X E 8 T X E <br /> MAXIMUM ALLOWABLE 8-T«X-E:LEVELS (PPM) 1 SC SO SO .S .3 1. 1» NA <br /> ample Result. ASOLItE 1000 100 10 <br /> AXIMUM ALLOWABLE TPN LEVELS (PPM) <br /> TAH ESEL 1 , O TflItE 100 <br /> t TROTES' If documnted soil and/or ground water contamination is present, do not corptate the leaching pot tial <br /> '3j-Am' analysis. i.e.,' site is currently on UOT -Contamination List-for sail or ground water,) <br /> ? <br /> \1 If depth Is > S ;ft. and c 25 ft,, sere 0 paints'. If depth <zS ft., dna not use table. <br /> if precipitation is > 40 inches, score 0 points. <br /> !S Leets far SYXE are >t apt labte at a TPT€ c c s°aticrs of 1C {grit 4� ) pc # tisel) <br /> Vt. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Ari ATX S E or Tis C strati ' � l;loable Levels: Yes o <br /> g R� tartd Sita Ctos�rre es If Yds, Refer to Sire titigari for Evllaai <br /> VII. REVIEW EVALUATION TO Be CCMPLETED SY A SUPERVISOR/SENIOR <br /> EA <br /> " TH STAFF TIES NCAtION '0 CLOSURE ETE NE" T SITE MITIGATION FOR EVALUATION ES' O' <br /> fERREtt 1 ATE CLtaSURE LETTEti (LEE <br /> EH Tis Eta (UCTWKSHT)\5/ O <br /> H 29 80 <br />