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SAN JOACUIN C Y JUBLIC HEALTH SERVI=-S/EHVIRCNMEVTAL HFA' IIVIS:CH l <br /> I ,r WORKSHEET FOR SITE CLOSURE _-VALUATICN OATEI [7—� <br /> NAME OF FACII�LLI, C r 5. ��Q�' f` �s-/�,�/r_'e� s'-,F— G[DEI y� 3/ <br /> IADORESSI UI3 I z lr��41 -Q <br /> (TANK SITl3iilK ' J * a� SfDc��r'(� <br /> LT / (FUEL TYPE 6'�..SD I/ <br /> i <br /> II. OENE.RAL SITE HISTORY <br /> Is :ermit current? Yesl INaI lPerait Sl - (Facility Sats Code � IOoc.Soi L/G'W Cant yes <br /> l lNo <br /> vomer of tanks at faeitityl (Age of Twks(if available)( lType of Tank I Steell IForgll Sngll OuaLl l <br /> .... SANK HISTORY <br /> vas rank tested? es lNol IFai led precision test ?IYesl INoI If yes, give care(s)l <br /> ':as a repair made to the rank syszw?lyes I _ MCI ltf Yes, what was rewi ree:7 <br /> vas recair done under inspeccion? Yes l INoI (Vere sail saaoles analyzea?l yesl INaI BTXEI (TPN,1 IiPH-Ol IPb/EOBI <br /> 'tape of failure/discharge) catastropnicf (lcn9-tenn teakagel Ioverfi Ali unk'm+nl lacier: <br /> :V. 1EVCVAL HISTORY (ATTACH INSPECTICN RERMT FOR SITE OEiAILS/COL—'-CT DATA FOR LEACMG POTEVTIAL ANALYSIS) <br /> Sail Samples Received iYes INoI (Death ca Graurd Water) IRet/Yearl (Average Annual Preeipi roti and A=l 14 110 PSI <br /> Cn-Sire 'JeLL(s)l Yesi INoI (Number i Typel lrrl jowl 1puol S Scare S Score i Score <br /> �Oistance to 'JeILCs) from Tankl ft; f:; C 10 ;Ls C 9 pu C 5 pts <br /> 0 if 0 if I 0 if <br /> A caiaitfan i conal ti art 7 condition <br /> IV. Site Feature - Leading PatenciaL Analysis E is .mc a is xi = is ai <br /> '�Ninia Oepth to graundwier ,"raa -4e Sail Sa Le (feet) I I >1QO l j51-iC0 � 125-50\1 � <br /> IF-sctures in suosur,ace (acpLies co foothills or m, re <br /> cain aas) l j Hare Ur:knawf I lPresent <br /> 'Average AmuaL Precipitation (inches) lxKzxxx{ <10 l 9 l 1C-25 I=M=l 25-40\2 <br /> 4an-9ade canauics +hick inresse vertical aigration <br /> of leachate (i.e., septic SYstms, weer velts, xnas) I Vane I i lnkrarn I IPresenc <br /> asZUnique site features: Recharge ares, coarse sail, nearby wells. Ac Lewel More than <br /> 1=,,l1 None Anel one <br /> i COLUMN iOTALA»TOTAL POINTS I <br /> �Sanele .Result: (S T X OR -) UN,(-e OF 70TAL ?CENTS 14.9 pcs or zare 61 - 4.a pts l l0 pts or less <br /> 3 i X 3 X <br /> MAXIMUM ALLOWABLE 3-T-X-. !NESS CPP") tI 50I 50` 50 I .3 ..3 i.l 1. NAV <br /> Saimle Result: GASOLINE 1000 l 100 l 10 <br /> MAXIMIDI ALLOWABI_` SPX 1.-MELS (PPM) <br /> TPX DIESEL 10,000 l 1000 I 100 <br /> P.MTNOTES: If doamefted sail and/or )mond water =Tcaainetion is ;resent, do not caolete the leading peteciaL <br /> analysis. (i.e., site is Curmncty an UGT Contamination List for sail or ?round water.) <br /> \1 If deeih is > 5 ft. and < 25 ft., score 0 paints- If aepth =5 ft., do not use vole. <br /> \2 If precipitation is > 40 inches, sere 0 p nw- <br /> \3 Levels far 3TXZE arc not applicable at a TPX aascencracion of TTOO ppa C('ge oline) or 100 ppv (diesel). <br /> 41. STAFF REC=4MENDATICN/CONCLUSION <br /> l <br /> I. Are 3TX Z E or TPH Concentrations > ALlowaole Levels "YesMCI <br /> ) <br /> ?. ieconnend Site CtosurclYesl INoI )-if Ya, .Refer m site Mitfgatian -"tar Evaluation Is <br /> _I� ll <br /> `,LOCCK/� r �/ hes nocL <br /> VII. IEVIEW EVALUATTCN • TO 3E C2WLEEM 3Y A SUPEQVISCR/SENICR S'I \�I ' �S�Yf.✓�'�hr+-'( O.Q���f�/,f/ <br /> l=11C)R WITH STAFF .RECCMMEVDATTCN FOR CLCSUREIYESI 1X01 (REFERRED 70 I. <br /> .,IT:rATTcm FOR EVA TICNI YES IN01 I f <br /> DATc REFERROI / / (DATE C-=RE LnTc4 9AIIM <br /> NAME OF <br /> E/ALUATCRI <br /> EH 23 SO (UGTWKSHT)\5/90 <br />