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SAN JOAQUINCl� �PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAT )IVISiON <br />Ih1T WORKSHEET FOR SITE CLOSURE EVALUATION 3i•/ <br />l SWEEPS COD <br />NAME OF FACILITY <br />_ _ n • n ITANK ID # <br />(TANK Si ZE <br />oe^) <br />FUEL <br />TYPEI <br />�r^��BPI.41✓ <br />Q 6�L{' <br />µp <br />Ref/Year <br />� <br />li. GENERAL S)TE HISTORY <br />Aver7Arompitation <br />A= <br />14 <br />10-25 <br />On -Site Well(s) <br />Yes <br />No <br /># <br />- <br />Facility <br />Status Lode <br />Doc.SoiL/GF <br />Is permit currant? <br />Yes <br />SScore <br />CO <br />R <br />E <br />No <br />Permit <br />S <br />a <br />R <br />E <br />Score <br />ifpts <br />condition <br />is met <br />Distance to Well(s) from Tank <br />ft; ft; ft <br />',Number of Tanks at facility <br />� <br />Age of Tanks(if available) <br />j3 <br />Type of Tank Steel <br />51-100 <br />FbrgL <br />III. TANK HISTORY <br />Fractures in subsurface (applies to foothills or mountain areas) <br />None <br />;Was Tank tes7under <br />Present <br />Average Annual Precipitation (inches) <br />Failed <br />precision test ?aessna <br />9 <br />10-25 <br />xxxxxxx <br />26-40\2 <br />If <br />yes, give date(s) <br />None <br />Was a repairk <br />system? <br />Yes <br />No <br />Ifired? <br />At least <br />one <br />Yes <br />COLUMN TOTALS>>>TOTAL POINTS <br />No <br />' <br />Were s? <br />Yes <br />INo <br />F 3v,(T <br />BTXEType <br />RANGE OF TOTAL POINTS <br />49 pts or more <br />was repair dtion? <br />40 pts or less <br />MAXIMUM ALLOWABLE B -T -X -E LEVELS (PPM) <br />B <br />1 <br />T <br />50 <br />X E <br />50 50 <br />B <br />3 <br />T <br />J. <br />X E <br />1. 1. <br />NA\3 <br />.Sample Result- S 0 <br />1- <br />TPN <br />MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br />GASOLINE <br />of failcatastrophic <br />100 <br />10 <br />DIESEL <br />long-term <br />1000 <br />100 <br />unknown <br />other. <br />INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL <br />ANALYSIS) <br />IV REMOVAL HISTORY (ATTACH <br />wrw <br />Cont Yes N <br />Sngl Dual <br />Soil Samples Received <br />Yes <br />No <br />Depth to Ground Water <br />µp <br />Ref/Year <br />; <br />Aver7Arompitation <br />A= <br />14 <br />10-25 <br />On -Site Well(s) <br />Yes <br />No <br />Number 8 Type <br />Irr <br />Dan <br />Puh <br />SScore <br />CO <br />R <br />E <br />if pts <br />condition <br />is met <br />S <br />a <br />R <br />E <br />Score <br />ifpts <br />condition <br />is met <br />Distance to Well(s) from Tank <br />ft; ft; ft <br />V. Site Feature - Leaching Potential Analysis <br />-.{G yy <br />;Minimum Depth to groundwater from the Soil Sample (feet) �� 1;/ 'p�7 <br />>100 <br />51-100 <br />25-50\1 <br />Fractures in subsurface (applies to foothills or mountain areas) <br />None <br />Unknown <br />Present <br />Average Annual Precipitation (inches) <br />xxxxxx <br /><10 <br />9 <br />10-25 <br />xxxxxxx <br />26-40\2 <br />Man -Made conduits which increase vertical migration <br />';of leachate (i.e., septic systems, water wells, ponds) <br />None <br />Unknown <br />Present <br />Unique site features: Recharge area, coarse soil, nearby wells. <br />None1 <br />At least <br />one <br />More than <br />one <br />COLUMN TOTALS>>>TOTAL POINTS <br />)xxxxxx <br />I l/ <br />' <br />�i <br />` n1 <br />; <br />I <br />F 3v,(T <br />,Sample Result: IS T X, 10 E) <br />�Tup,W9-Ail 0 <br />j <br />RANGE OF TOTAL POINTS <br />49 pts or more <br />41 - 48 pts <br />40 pts or less <br />MAXIMUM ALLOWABLE B -T -X -E LEVELS (PPM) <br />B <br />1 <br />T <br />50 <br />X E <br />50 50 <br />B <br />3 <br />T <br />J. <br />X E <br />1. 1. <br />NA\3 <br />.Sample Result- S 0 <br />1- <br />TPN <br />MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br />GASOLINE <br />1000 <br />100 <br />10 <br />DIESEL <br />10,000 <br />1000 <br />100 <br />.. <br />Ies�Fir•n mt�nilal <br />FOOTNOTES: -if documented soil and/or ground water contamtnatl Yn is P,_<�=��., �.. ••-• --•r---- -- -------- <br />,7 analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br />1 \l If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table- <br />) G{y1�Y.\2 if precipitation is > 40 inches, score 0 points. <br />�p.), i \3 Levels for BTXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br />STAFF RECOMMENDATION/CONCLUSION <br />1. Are BTX 8 E or TPH Concentrations > Allowable Levels .Yes I I <br />No %` <br />ues o <br />2 Recommend Site Closre Refer to Site Mitigation for Evaluation <br />_ �uocevf CflO /CFV InQ <br />V:1 <br />.. MCYICN Cvn�Ynavn •.- .... ��- <br />CONCUR WIT" STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br />DATE REFERRED / / DATE CLOSURE LETTER MAILED <br />NAME OF <br />EH 23 80 (UGTWKSHT)\5/90 <br />