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SAN JOAQUIN C . PUBLIC HEALTH SERVI=-S/ENVIRCNMENTAL HEi. IVISICH <br /> I. Lsrf 'WORKSHEET FOR SITE CLOSURE EVALUATION OATEI LtL J�%._ 61 (% <br /> (NAME OF FACILITY 1 1 /(_ , ISLE=oS CME( a <br /> AOORESSIJS�q,OJq ITANK IO 413 <br /> TANK SIZE( /a 1600 I FUEL TYPE( Di e <br /> It. GENERAL SITE HISTORY <br /> Is permit current? les X Nal (Permit dl - IFaci Lity, Stats Code (Doc-SaiL/Gu Cwt l Yesl INoI <br /> muncer of Tanks at facility) (Age of Tanks(if available)( �q:,,J Type of Twkl SCeet XIFbrgtl ISngtl ouaLl <br /> ..,. TANK HISTORY <br /> was Tank tested? Yes 1XINo Failed precision test ?(Yes No XIf yes, give date(s)I <br /> ,:as a repair made to the tank system;lyes No If yes, what was repaired?( <br /> i i l ! a! I I I I I I <br /> ':as repair done under inspection? yes Na were sail samules analytes. Yes Wa BTX£ TPN-G TPX-0 Pb/EDB <br /> .ype of failure/discharge) catastrophic) hong-team Leakage) o rfi Ll) (unknown) )otter: <br /> iV. REMOVAL 'HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLL"-"-CT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> 'Soil Sales Recei vedlYesl NoI (Depth to Ground Water�� Ref/Yea )Average An uat Precipitationl A-l14 I10-Z51 <br /> Cn-Site WeIL(s)IYes INoI (Number 3 Type] Irr1 low IIPub I <br /> S Score S ScoreS Score�Distance to Wetl(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 ifnd .R <br /> i Coition condition R condition <br /> IV. Site Feature - Leaching Potential Analysis _ is met is mer C is met <br /> Mininmm Oenth to groundwater frtm the Soil Sample (feet)jQ-- 1 >l0(1 I 151-too q 125-i0\t <br /> IF-sctures in subsurface (aoplies to foothills or mamsitain areas) 1 D Hone ] Unknown ✓ (Present <br /> 1 I <br /> lAverage Annual Precipitation (inches) IxzzxxX� <10 I 9 110-25 XXX:a:c< 26-40\Z <br /> '.Man-Made conduits which increase vertical migration i <br /> '.,af Leachate (i.e-, septic systems, water 'x(Ls, ponds) I Hone i Unknown � Present <br /> Unique site features: Recharge area, Coarse soil, nearby wells- At least More than <br /> =,= None we we <br /> I <br /> COLUMN TOTALS»>TOTAL POINTS I (/ <br /> i8 10 38 <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pis or more I 41 - 4a pts 40 PCs I <br /> rK,1 k A � <br /> �� � MAXIMUM ALLOWABLE 3-T-X-E LEVELS (PPM) 1 50 50I 50 .3 .3 1- 1. NAv3 <br /> Sanrole Result: GASOLINE 1000 I 100 I 10 <br /> 7-K i t 7 3 w1 MAXIMUM ALLOWBLE TPH LEVELS (PAM) <br /> TpXsD O[ESE3. 10,000 I 1000 100 <br /> P•roTNOTES: " If documented soil malar ground eater contamination is present, do not complete the Learning <br /> anetysis- (i.e., size is currentty on UGT Contamination List for sail or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth c5 ft-, do not use table. <br /> \Z If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXEE are not applicable at a TPN concentration of 1(I Ppm (gasoline) or 100 Ppm Cdiesei)- <br /> VI. STAFF 3ECrKMENDATIOWCONCLUSION <br /> T/f 1 ,4' pQ s sus G p <br /> 1. Are 3TX & E or TPH Concentrations > Allowable Levels I"ft INo <br /> 2. 3eco=m:nd Site Closure)Y"jX Ho] ?If Yes, Refer to Site Mitigation for Evaluation <br /> v <br /> Y[I. RE'/tEu EVALUATION - TO 3E CpMPLRE0 3T A SUPERVISOR/SEMIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE]YESI HOI (REFERRED TO SITE .MITIGATION FOR EVALUATICNIYESI iN01 <br /> DAT'c REFERRED( / / IOATE CLOSURE LETTER .MAIL91 / / <br /> NAME OF I <br /> EVALUATORI <br /> EH 23 30 (UGTWKSHT)\5/90 <br />