Laserfiche WebLink
SAN JOAOUIN�_oNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL N,,.O1 DIVISION <br /> 1. UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE •�` 3 <br /> qME OF FACILITY (AN I1Qs OG Oh ) WEEPS CODE aLq�s <br /> ADDRESS 33 N. / I U r oio 51, ANK ID # oLi1Jr—I <br /> TANK SIZE !Jlv UEL TYPE e9 99So Ihe. <br /> II. GENERAL SITE HISTORY <br /> Is permit current? es o ermi[ # aci(ity Status Code oc.Soil/GW Cont es !o <br /> umber of Tanks at facility ge of Tanks(if available) ype of Tank Leal Fbrgl ngl Dual <br /> III. TANK HISTORY <br /> :as Tank tested? es IF <br /> ailed precision test ? IT es I o If yes, give date(s) <br /> Was a repair made to the tank system? Yes No f yes, what was repaired7 <br /> Was repair done under inspection? es o arc soil samples analyzed? es !o TXE PH-G PH•D b/EDB <br /> Type of failure/discharge atastrophic 1 long-term leakage verfill nknown ther: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> mil Samples Received as ✓ o epth to Ground Water j S of/Year �� 80 verage Annual Precipitation = 4 10-25 <br /> )n-Site Wett(s) es o ✓ umber 8 Type I Irr I ub <br /> S core S Score 5 Score <br /> istance to Well(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> ' 0 if 0 if 0 if <br /> R ondition R condition R zondition <br /> V. Site feature . Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) 3r /�/'��-� )100 1.100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) I (� None Unknown resent <br /> verage Annual Precipitation (inches) KXXXXX 00 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) C) None Unknown resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. (f At Least ore than <br /> xxxxx None _LI one 2 one <br /> 3 <br /> COLUMN TOTALS>>>TOTAL POINTS 33 -' <br /> 'ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 . 48 pts 40 pts or less <br /> \ B T X E B T X E <br /> U ' 0C MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 i. 1. NA\3 <br /> 'ample Result: ASOLINE 1000 100 10 <br /> 0',� ( AXIMUM ALLOWABLE TPN LEVELS (PPM) <br /> TPN IE SEL 10,000 1000 100 <br /> OOTNOTES: ***If documented soil and/or ground water contamination is present, do notcomplete 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 not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1, Are BTX 8 E or TPH Concentrations > Allowable Levels Yes 0 <br /> 2. Recommend Site Closure 1Yes o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION • TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE IFES '0 EFERRED TO SITE MITIGATION FOR EVALUATION ES !0 <br /> TATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME <br /> OVA: <br /> EH 23 BO (UGTWKSHT)\5/90 n <br /> Ex 29 80 /Y <br />