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SAN JOAQUIN CX'vTY PUELIC HEALTH SEiVICS/EYVIRCNMENTAL :HEALTH OIVISICN <br /> L. '.=KSHEET PCR SIie CCSURE EVALUATION OATE Z/)- i.� G fU <br /> NAME OF FACILITY I �1L.f �v /C (SHE=oS CCOEI <br /> IADCRESSI 6XO Er / /(CeJn c;'� (TANK CO ;tl <br /> (TANK SIZE1 (FUEL TYP<_I <br /> GC/�� <br /> [I. ;EHERAL SITE HISTORY <br /> 'Is Permit current?IYes X MCI jp,,mit :I Facility Salts Cade) �IOec.SaiUCJ C=CIY.l INaI <br /> .Hueter of Tanks at facility? '7 (Age of Tanks(if avai La=Le)I / 9 IType of rwkl Steatj y�F6rgLI lSngll ou t <br /> :II. TANK HISTORY r /" <br /> 'uas Tank cested7l Yes 1Nol (Failed Precision .est ?1YeeI IXel Iif yes, give date(s)1 <br /> ';as a repair made to the tank Systeer?lTeel Hal IIf yes, what was repaired?( - <br /> ':as repair done under inspection?ITeeI INoi Iyer sail samples analyzedllYeel IYoI BTXEI IMM-1 ITPX JI IPb/5]gI <br /> Type of failure/discharge) Icatastrophicl ILong-tem Leakagel Iovern LLI Irl Iot3er: <br /> iV. HEIOVAL HISTORY (ATTACH INSPECTION .i REPORT :OR 311-c 0STAILS/COLD OATA FOR 'EACHING POT-ENTIAL ANALYSIS) <br /> '.Soil Samples Reeei vedlYesl INoi IOepth a ;:eund Vater? IRef/Yearl (Average AmuaL Precipitatienl A-114 110-251 <br /> Cn-Sita VeIL(s)IYesI INaI INumber 3 Typel Irrl IDan Peal <br /> S SCOrT S Score S Spf4 <br /> !O,stance t0 4eLL(s) from Tank Ft; C 10 Pts C 9 pts C 5 pts <br /> O if D if0 if <br /> 3 on <br /> cdition R cwcitiw .4 condition <br /> IV. Site Pea Lure - Leaching PCLentiaL AnatYSi3 i5 get - IS net i3 i!L <br /> Mlnimuo Oepth to groundwater from me Soil Samdle (feet) l I .;GO 1 �51-i00 i 25-50\l <br /> P-adores in sucsurface (aeptiee -o Foothills or .wuntain areas) 1 .Vane I I Unknow I 1Present <br /> i <br /> Average Annual Precipitation (inches) j=ccu I <10 1 9 1 10-5 IXxoocc(I ?5-40\2 <br /> '..Man-Made candAait3 whiCil increase werticaL aigratian <br /> of teechate (i.e., septic systeea, water wells, Ponds) I l .Vane j Unknow I Prezent <br /> Unique site Festuras: Recharge area, coarse sail, nearby wells. IAt Least Me" ;hon <br /> M T p�t Hone dr a one <br /> COLL34M TOTALA»TOTAL POINTS <br /> `_amcle Resul:: (9 T X OR _) RANGE OF TOTAL POINTS 49 pu �a <br /> or 0r_ I 4t - 48 Pts 1 40 pts or Less <br /> n< Al /UD <br /> TK S, 3! ; x ; E 3 X <br /> MAXIMDH AUM"LE 3-T-I-E LEVELS (PPM) 1 ;;-OI SDI i0 3 3 11.I 1. I NA\3 <br /> {Sa ie Result: GASCLINE 1000 I 100 I 10 <br /> -! K / S' � N MAXIMRI sn r rnum c �X LEVE!S (PPM) <br /> TPX DIESEL 10,000 I 1000 I 100 <br /> F•COTNOTES: —If documented soil and/or ground water contaacnation is presw= do nde cdclete a Leaening potentiaL <br /> analysis. (i.e., site is carrentty on OGT Corrtminatim list For soil or g ere) <br /> \1 If death is > 5 ft. and < ZS ft., score 0 points. If cepth ci ft., do not use MOLe. <br /> \Z If precipitatim is > 40 inches, sere 0 points. <br /> U Levels for 3T ME are not applicabte at a TPN � ration of 10 ppa (gasoline) or 100 ,3m (diesel.). <br /> VI. STAFF RECCMMENOATICN/aMCUMICH <br /> 1. Are 3TX A E or TPX Canccltratl0ns > ALlowble Lavels I-Yeel (Nei <br /> 2. Reconmmr'd Site CtosureI Teel INaI �I>If Yes, .Refer to Site Mitigation for Evalwtiml <br /> VII. REVIEW EVALUATTCH - TO 3E COMPLETED 3Y A SUPORVISOR/SEXICR <br /> GVCJR '41TH STAFF RECCMMENDATICN POR CIASIIREIYESI NOI (REFERRED TO SITE MITIGATION FOR EVALLIATICNIYES( iN01 I i <br /> DAT-c REPEiRED OATE CL0.SURE L-M,ER AASL71 <br /> i <br /> NAME OF <br /> E'rALLATCR I <br /> EH 23 30 (UGT4KSHT)\5/90 <br />