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SAN JOACUIN CLUNrY PUSUC HEALTH SENT=-SISMCNMEHTAL HEALTH OIVISICH <br /> 1. ' '.McRKSNEET ..:OR SITE CL09URE EVALUATION OATE7I <br /> (NAME OF FACILITY �� � /� 1SWEaS CDEi <br /> ADORE"aSI S(�O! . i(CQ/h'f/Gr7?/U (TANK i0 -13q <br /> (TANK SIZE( /��DQO (FUEL TYPEI4/e��/. ✓ 7 <br /> [I. GEMERAL SITE HISTORY <br /> is =emit atrrent?IYes x INoI Fair 31 - (Facility Status Cadej C,,A IOac-SoiL/GI Cant Yesl INoI <br /> .vomer of Tanks at facility7 1Age of ianks(if availablU I IC7 (Type of TanklSteell (Fbrgll ISngII 0w11 <br /> TANK 41STCRY C / <br /> 'as rank :ested7l Yes HoI 1Fai led precision :est ?IYes I INoI y If yes, give dace(s) <br /> ,;as a repair made to the :ars. SYstem'1IYcI Hal xif yes, what was repaireGll (— D (i21,5-f <br /> :as repair done under inspection l yesl No; IWere soil samcles soalyzed7 I Yes INoI BTXEI ITP4-G1 ITPH 31 iPb/EOBI I <br /> 'Ype of 4ailure/tli5charge) lratastrvphicl hang-term Leakagel Iaverfil Ll urdamwl lather: <br /> 711. IF-MOVAL 'HISTORY (ATTACH INSPECTION .REPORT FCR SITE DETAILS/COACT DATA FOR '°ACHING POTENTIAL ANALys IS) <br /> SoiL SamoLes ReceivedlYesl INoI (Depth to i,-au 'Jaterl I0.ef/Year1 IAvera9e AnnsnL arecipicatian1A=I14 110-251 <br /> ICn-Site 'JeLL(s) YesI INoI (Number i Type) Irrl Owl IPuc <br /> S Score S Score S Sprc <br /> �Discance to 'Jell(s) frw Tar* ft; t C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> 3 iti <br /> condon .R condi cion .R condi ci on <br /> Iv. Site Feature - Leaahirg PotentiaL Analysis - is sec is ,rat is at <br /> IMinimim Oecth to greurc'wcer frw the Soil SaACLe (feet)s0--/yaej3(o I >100 1 151-100 S I. L-50\1 <br /> ,-ures in Subsurface (o=ptic M roathilLs or m. Iain areas) 1 I [} I Yore I 'Jnkrawn iPraent I <br /> Average AnnuaL Precioitacian (inches) Ina>xxl <10 1 9 110-LC j=xx, j 25-40\2 I <br /> can-Made CdndtJits which inCrceae vertiCal .e19"Zim <br /> of Lescnate (i.e., septic systems, water veils, ands) I .von. f Unknown I Present <br /> Unique site features: Redfarge area, caarse sail, rearoy jells. .vane y/q At Leas:ax More dean <br /> i waPx one <br /> pILANI rOTALA»iQTAI 70[HTS <br /> nm <br /> y' R�uI�K �7X OR E) IANGE OF TOTAL MINTS Q pts or mor- �� - =3 pcs 7 x <br /> 4 u", _ -D MAXIMIM ALLOWABLE 3-T-X-= LEVELS (PPM) 1505050 3 3 i.1 1Saoole lesuLt: GASOLINE 10a I00TK it £ T K MAXIMIM Ar i MM& a rax LEVELS (PPM) <br /> DIESEL 10,000 1000•ODTNOTES: —if docimmced sail and/or ground water contamination is present, do ndt caplets ticanalysis- (i.e site is currentty on UGT Cantaminatfan List for soil or 1.= <br /> \1 if depth is > 5 ft- and < 25 ft., score 0 poin=- If ae=. �5 it., dd not use table. <br /> \2 If precipitation is > 40 inrches, scare 0 points- <br /> \3 Levels for 3TXSE arc not applicable at a TPR cacosmrrion of 10 ,ope (gasoline) or 100 pPo (dices/). <br /> 111. STAFF .RECCMMENDATION/CCHCLLSICN 7 -x131-P <br /> 1. Are M i E m <br /> or TPH Corctra atior > ALLawacle Levels I'YnI INoI I, <br /> � ?. 3ecMmer+d Site CtasurelYes No �If Yes, Refer to Site Mitigation for Evalwci an <br /> r <br /> `Ili. HE`/f EW EVALUATION - TO 3E CAPLETED 3Y A SUPeRVISCR/SEMICR <br /> CONCUR 'JITH STAFF .2ECCMMEYOATICN FOR C.DSIIREIYESI N01 REraiRED TO so-E MITIGATION FOR EVALUATICHIYESI (MOI I 1 <br /> DATE REFERRED ICAT'e CLOSURE LETTER MAIM <br /> NAME OF <br /> E'/ALUATORI <br /> E4 23 30 (UGTWKSHT)\5/90 <br />