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SAN JOAOUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAALTH DIVISION <br /> 1' UGST WORKSHEET FOR SITE CLOSURE EVALUATIONJ <br /> ATE /� 7j <br /> c, _ <br /> AME OF FACILITY / <br /> WEEPS CODE <br /> OGRESS -��� S <br /> ANK 512E 'u,DC) 4I UEL TYPE VU-u✓ <br /> II. GENERAL SITE HISTORY <br /> Is pe!MUE!9 <br /> or it acit ity Status Code oc.Sall/CW Con[ es 10 <br /> umbee of ianks(if available) <br /> ype of Tank [eel Fbrgl ngl Dual <br /> III. TANK HISTORY <br /> as Tank tested? as 0 ailed precision test ? as <br /> o If yes, give date(s) <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> as repair done under inspection? es o ere salt samples analyzed? es to TXE I ITPH-G I kPH-n I 6hirnn <br /> ype of failure/discharge atastrophic long-term leakage verfill mknown ther: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Sables Received as o epth to Ground Water -5) of/Year / verage Annual Precipitation = 4 10-25 <br /> •Site Well(s) res I o I umber 8 Type Irr I an I b <br /> istence to welt(s) from TenkS core S core S core <br /> ft; ft; ft C 0 pts C pts C <br /> 0 if 0 if 0 tP[s <br /> Site Feature - Leaching Potential Analysis R ondition R ondition R ondition <br /> E is met E is met E s met <br /> inimum Depth to groundwater from the Soil Sample (feet) 100 <br /> mP )3D-W•5= 155 > 1.100 � 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) <br /> I D None Unknown resent <br /> verage Annual Precipitation (inches) <br /> xxxxx c10 9 10-25 xxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration Q <br /> f Leachate (i.e., septic systems, water wells, ponds) —1 <br /> None Unknown resent <br /> Inique site features: Recharge area, coarse soil, nearby Wells. <br /> At least ore than <br /> xxxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS jQ 2 C 3 <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> ,03. FM Kyler\e <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. E <br /> 1. NA\3 <br /> -ample Result <br /> AXIMUM ALLOWABLE TPH LEVELS (PPM) ASOLINE 1000 100 10 <br /> TPH IESEL 10,000 1000 <br /> 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 /> \3 Levels for BTXBE are net applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel) <br /> V1. STAFF RECOMMENDATION/CONCLUSION p <br /> 1. Are BTX 8 E or TPH Concentrations > All wable Levels Yes o I` <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - 10 BE COMPLETED BY A SUPERVISOR/SENIOR <br /> .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE 'ES '0 EFE!MA <br /> TO SITE MITIGATION FOR EVALUATION ES t0 <br /> ATE REFERRED / / ATE CLOSURE LETTERED <br /> / / <br /> AME OF � „ / �/� - <br /> :VALUATOR �/Z <br /> EN 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />