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SAN JOAQUIN CCUNTY F 1C HEALTH SERVICES/ENVIRONMENTAL HEALTH DM ON <br /> UGST WACSHEET FOR SITE CLOSURE EVALUATION — ATE <br /> --E OF FACILITY �M/ Zj4J_(I—1iSWEEPS CODE <br /> 10 RE 55 ? � ANK ID % // qC --c <br /> aNK SIZE `)c)0 UEL TYPE <br /> GENERAL SITE HISTORY <br /> s permit current? es o ermit it acility Status Code LLL oe.Soil/GW Cont es Uo <br /> u.cer of Tanks at facility Be of Tanks(if available) Type of Tank IS teel I IFbrgl I ISngl Duall <br /> . TANK HISTORY <br /> 'as Tank tested? es o ailed precision test 7 es o If yes, give dace(s) <br /> ,as a repair made co the tank system? es No f yes, what was repaired? <br /> Has rebair dome under inspection? ea 0 Pere soil samples analyzed? 1Y,, j `lo TXE I PH-G ITPH-O b/EDD <br /> Yoe of failure/discharge atastrophie long-term leakage verfill I nown Cher: <br /> REMOVAL :HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT TATA FOR LEACHING POTENTIAL ANALYSIS) <br /> soil Samoles Received es o epth to Ground Water of/Year ver age Annual Precipitation + 4 10-25 <br /> n•Si;e Wal l(s) es o umber 3 Type Irr I bo- <br /> b <br /> 5 core S core 5 core <br /> Pts 0 <br /> ft; ft; ft C 0 pts C <br /> H stance to ueLl(s) from Tank C pts <br /> •O -f C if -f <br /> R ondi tion R atdition R ondition <br /> �. Site Feature - Leaching Potential Analysis E �is met E is net Es .met <br /> O nimuo Depth to groundwater from the Soil Sample (feet) I >100 1.100 25.50\1 <br /> :rac;ures in subsurface (applies to foothills or mountain areas) O None Unknown resent <br /> Overage Annual Precipitation (inches) xxxx <10 9 10-25 xxxxxx 26-40\2 <br /> 4an-Made conduits which increase vertical migration <br /> :f leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> :niwe site features: Recharge area, coarse soil, nearby wells. /] At least ore than <br /> xxxx None "1 ane l/one <br /> COLUMN TOTALS»>TOTAL POINTS <br /> -a,m7ple,/Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 771 GS pcs I 40 pts or less <br /> v Y. � C / B T % 3 T X E <br /> MAXIMLRH ALLOWABLE B-T•X-E LEVELS (PPM) 1 "c 50 50 50 I .3 .3 1. 1. NA\3 <br /> sample ResulpSOLINE 1000 100 10 <br /> AXiMUM ALLOWABLE TPH LEVELS (PPM) <br /> 1200 TPH IESEL 10,000 1000 100 <br /> FOOTNOTES: •"If doeunenced sail and/or ground water contamination is present, do not complete 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 r_5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TX&E are rot applicable at a TPN concentration of 10 ppm (gasoline) or 100 opm (diesel). <br /> STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are 3TX 3 E or TPH Concentrations > Allowable Levels Yes 001 <br /> 2. Recommend Si cc Closure es If Yes, Refer to Site Mitigation for Evaluation <br /> I. REVIEW EVALUATION - TO 3E CCMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR "cVALUAT ION IDES 10 <br /> ATE REFERREC PA'.E CLOSURE LETTER MAILED ' i / { <br /> i <br /> 2N 23 <br />