Laserfiche WebLink
SAN JOAQUIN *Y PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAPDIVISION ATE I!L 2 '� 3 <br />UGST WORKSHEET FOR SITE CLOSURE EVALUATION <br />AME OF FACILITY Dott "CILSB,/) y,, toy, <br />�,,, WEEPS CODE �15� <br />DDRESS �K Z�.' SCiJ'i� 1. 000)ln StUc_ V -to' � ANK ID # `Sl - [1,51 , t <br />TANKip <br />SIZE llp�� yQ UEL TYPE (ot5 <br />. GENERAL SITE HISIUNY <br />;s permit current? es o ermit # acility Status Code 52 oc•Soil/GW Cont es Jo <br />umber of Tanks at facility I ge of Tanks(if available) UdXIL[Type of Tank teel brgl ngl I Dual <br />i. I I I I n, aI VII <br />Jas Tank tested? <br />es <br />o <br />ailed precNtestes <br />o <br />If <br />yes, give date(s)as <br />a repair made to the tank system? eses, What Was repaired?ns <br />,oil Samples Received <br />repair done under inspections <br />es <br />l samples analyzed? <br />es <br />epth to Ground Water <br />to <br />of/Year <br />-G <br />PN -D <br />b/EDD <br />es <br />ype of failure/discharge <br />o <br />atastrophicakage <br />umber & Type <br />verf ilt <br />nk noun <br />the <br />IV REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/CULLECI DAIA rUn LtMIni"C r�To; .,.. ...... ,.•... <br />VI. STAFF RECOMMENDATION/CONCLUSION —/ yr INIM 10 0 VYtyI�'�( 1 L <br />1. Are OT% & E or TPH Concentrations > Allowable Levels Yes o 1 1� <br />2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation /T�`�,yyY4,CDVtIc-LdIL]✓1,"�J�Q�I%� <br />VI' T,III - T^ ac rn�r, Prrn RY A SUPERVISOR/SENIOR ulonta t.tvia-ft �1 now <br />.ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE 'ES '0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 40 <br />DATE REFERRED / / ATE CLOSURE LETTER MAILED <br />AME OF <br />E.VALUAT OR <br />EH 23 80 (UGTWKSHT)\5190 <br />EH 29 80 <br />,oil Samples Received <br />es <br />o <br />epth to Ground Water <br />35 <br />of/Year <br />ve rage Annual Precipitation <br />In -Site Wells) <br />es <br />o <br />umber & Type <br />Irr <br />am <br />ub <br />S <br />3core <br />S <br />C <br />3core <br />10 pts <br />S Score <br />C 9 <br />pts <br />C <br />5 pts <br />if <br />Distance to Wells) from Tank <br />ft; ft; ft <br />0 <br />R <br />E <br />if <br />onditi on <br />is met <br />0 if <br />R condition <br />E is <br />met <br />0 <br />R <br />E <br />zondition <br />is met <br />V. Site Feature - Leaching Potential Analysis <br />inieium Depth to groundwater from the Soil Sample (feet)35,:751aj CJ <br />>100 <br />1-100 <br />5 <br />25-50\1 <br />ractures in subsurface (applies to foothills or mountain areas) <br />I� <br />None <br />Unknown <br />resent <br />verage Annual Precipitation (inches) <br />xxxxxx <br />c10 <br />9 <br />10-25 <br />xxxxxxx <br />26-40\2 <br />nn -Made conduits which increase vertical migration - <br />q <br />Unknown <br />resent <br />f leachate (i.e., septic systems, water wells, ponds) <br />None <br />Inique site features: Recharge area, coarse soil, nearby wells. <br />q <br />At least <br />ore than <br />one <br />xxxxx <br />None <br />one <br />�� <br />i <br />2 <br />; <br />COLUMN TOTALS»>TOTAL POINTS <br />'ample Result: (0 T X OR E) <br />RANGE OF TOTAL POINTS <br />9 pts or more <br />41 48 pts <br />40 pts or less <br />3•D ppH+ 1 <br />MAXIMUM ALLOWABLE B -T -X -E LEVELS (PPM) <br />B <br />1 <br />T <br />50 50 <br />50 <br />.3 <br />.3 <br />1. <br />1. <br />NA\3 <br />-ample Result: <br />ASOLINE <br />1000 <br />100 <br />10 <br />ppn'n TPH <br />AXIMUM ALLOWABLE TPH LEVELS (PPM) <br />IESEL <br />10,000 <br />1000 <br />100 <br />FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the teaching 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. ppm (gasoline) or 100 pyn (diesel). <br />\3 Levels for BTX&E are not applicable at a TPH concentration of 10 <br />� n D11 <br />VI. STAFF RECOMMENDATION/CONCLUSION —/ yr INIM 10 0 VYtyI�'�( 1 L <br />1. Are OT% & E or TPH Concentrations > Allowable Levels Yes o 1 1� <br />2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation /T�`�,yyY4,CDVtIc-LdIL]✓1,"�J�Q�I%� <br />VI' T,III - T^ ac rn�r, Prrn RY A SUPERVISOR/SENIOR ulonta t.tvia-ft �1 now <br />.ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE 'ES '0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 40 <br />DATE REFERRED / / ATE CLOSURE LETTER MAILED <br />AME OF <br />E.VALUAT OR <br />EH 23 80 (UGTWKSHT)\5190 <br />EH 29 80 <br />