Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION _� 1 -`1 <br /> 'I. LOST WORKSHEET FOR SITE CLOSURE EVALUATION ATE l <br /> 71 <br /> AME OF FACILITY T"f VlLa, 0s4A+e- WEEPS CODE <br /> ODRESS 32� S, C4L -�OVrA 16�.. '�� ANK ID # <br /> VTANK SIZE Wj)Q 0,C UEL TYPE <br /> If. GENERAL SITE NIST RY <br /> Is permit current? es o ermit #loI acility Status Code OC.Soil/GW Cont as o <br /> umber of Tanks at facility ge of Tonks(if available) IType of Tank Leel IFbrgl ngl Dual <br /> Ill. TANK HISTORY <br /> as Tank tested? Ires o ailed precision test ? Ifas I o If yes, give date(s) <br /> Jas a repair made to the tank system? es No 11f yes, what was repaired7 <br /> Joe repair done under inspection? 40 ere soil samples analyzed? as to I T%E I PH-G I PH-D I b/EDB <br /> ype of failure/discharge atastrophic long-term leakage I 10yerfilt I lJnknown I lother: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es o epth to Ground Water I 1Vof/Year verage Annual Precipitation = 4 0.25 <br /> )n-Site Well(s) Ifas I o umber 8 Type Irr I om I ub <br /> S Score 5 core S core <br /> istance to Wells) from Tank ft; ft; ft C 10 pts C pts C 5 pts <br /> 0 if 0 1f 0 if <br /> R ondition R ordit1on R ondition <br /> 1. Site Feature - Leaching Potential Analysis E is met E is met E is net <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 .—. 1.100 25-50\1 <br /> raetures in subsurface (applies to foothills or mountain areas) 10 None Unknown resent <br /> verage Annual Precipitation (inches) KXXXXX 00 9 10.25 KXXXXXX 26-40\2 <br /> an-Made conduits which increase vertical migration - <br /> f leachate ((.e., septic systems, water wells, ponds) None Unknown resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. mit At Least (ore than <br /> xxxx None I one one <br /> COLUMN TOTALS»>TOTAL POINTS + V + rf 3 <br /> �( ample Result: (S T X OR E) RANGE OF TOTAL POINTS 9 torore 41 - 48 ptsBE B i X E <br /> a 2� r� MAXIMUM ALLOWABLE B-T-%-E LEVELS (PPM) 150 .3 .3 i. 1. NA\3 <br /> amele $esuit: vE, ASOLINE- 1000 100 10 <br /> N()Q�` A%IMUM ALLOWABLE TPN LEVELS (PPM) <br /> 1, L TPH IESEL 10,000 1000 100 <br /> OOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potentia! <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 STXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX 8 E or TPH Concentrations > Allowable Levels Yes o <br /> 71 <br /> I2. Recommend Site Closure es o I If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE C014PLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES I 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES O <br /> ATE REFERRED / / ATE CLOSURE LETTER )AILED <br /> .VALUATOR ( <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> EH 29 80 <br />