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SAN JCACUIN COUNTY PURL ALTH SERVICFS/ENVIRONMENTAL HEALTH DIVISt. <br /> UGST WCRKJf FOR SITE CLOSURE EVALUATION ATE <br /> F FACILITY ^ EEPS COOE J <br /> S <; � at'41 AHK IO <br /> !2E UEL TYPEn�Q 1,p� •� I� <br /> 7, Z— <br /> RAL SITE HISTORY ;71 4100 <br /> mi; current? es o ermit d �acitityAtatuS Code oe.soil/GW Conti es No <br /> of Tanks at facility ge of 7anks(if available) ype of Tank reel iFbrqL ngl Dual <br /> K '.HISTORY <br /> nk tested? i es o ailed precision test ? es o if yes, give date($) <br /> repair made to the tank system? kes No f yes, what was repaired? <br /> Pair done under inspection? es o � ere soil samples analyzed? iY as I Io TXE PH•G 194.0 b/EDD <br /> f failure/discharge acastrocnic I long-term Leakage pverfill I noun I cher: <br /> 'JAL HISTORY (ATTACH INSPECTION REPORT FOR SITE )ETAILS/COLLECT ;ATA FOR LEACHING POTENTIAL ANALYSIS) <br /> amoles Received es o eoth to Ground Water 1,7-o of/Year h verage Am l Precipitation • 4 10.25 <br /> e '+'eLl(s) es o tnMber i Type Irr pan o <br /> S core S IScore S core <br /> Fe to WeIL(s) from Tank ft; _ft; ft C 0 pts C 9 pts C Pts <br /> 0 'f 0 lif 0 'f <br /> I kondition R pts <br /> R ondi tion <br /> ice Feature Leaching Potential Analysis ° his not E Its met E $ net <br /> Depth to groundwater from the Soil Sample (feet) >100 �51.100 „P 25-50\1 <br /> ures in subsurface (applies to Foothills or mountain areas) fj Hone Unknown present <br /> ge Annual Precipitation (inches) Xxxa I <10 I 9 10-25 Xxxxsx 26-40\2 <br /> ace conduits which increase vertical migration �, <br /> senate (i.e., septic system, water wells, pon ) Hone a Unknown resent <br /> ds <br /> e site features: Recharge area, Coarse soil, nearby wells. qqq At least are than <br /> Xxxx Nprwt One One <br /> COLUMN TOTALS»>TOTAL POINTS /n k- 7 <br /> e .Result: (3 T X OR E) RANGE OF TOTAL POINTS 4.9 pts or more 41 - 43 pts 40 PCs or Less- <br /> s i X EE 3 T 11E <br /> MAXIMUM ALLCUASLE 3-7-X-E LEVELS (PPM) 1 50 50 50 I .3 .3 1. 1. NA\3 <br /> e Result: OLINE 1000 100 10 <br /> / IMUN ALLWA13LE TPN LEVELS (PPM) <br /> VPI TPN �IESEL 10,000 1000 100 <br /> OT-S: --tf documented soil arW/or ground eater contamination is present, eo not comolete 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 --each <-5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TXEE are not applicable at a TPN concentration of 10 pee (gasoline) or 100 ppm (diesel). <br /> FF R9COt'MEVOATION/CONCLUSION �!, <br /> Are 3TX i E or 1P4 Concentrations > Allocable Levels Yes o Lti (2. C <br /> Recommend Site Closure n o I V1 It Yes, Refer to Site Mitigation for -Evaluation <br /> V 7 / <br /> VIEW EVAIUAiICN - TO 3E COHPLETE7 7Y A SUPERVISOR/SENIOR <br /> ICUR WITH STAFF RECOMMENDATION FOR CLOSURE pE5 EFERRED TO SITE MITIGATION FOR EVALUATION �Es `VO <br /> 4EFERREC rxfE CLOSURE LETTER MAILED <br /> i <br />