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SAN JOACUIN COUNTY4EALTH SERVICES/ENVIRONMENTAL HEALTH DIV N <br /> UGST £ET FOR SITE CLOSURE EVALUATION . ATE <br /> "E OF FACILITY lLQ��7 y�/� /0/2y, EEPS CODE <br /> DRESS < ' �L�/ltiL/ l�! (y LANK 10 <br /> NK SIZE UEL TYPE ?, <br /> GENERAL SITE HISTORY <br /> Is permit currentl Ifes o ermit it I acility Status Code oc.Soil/GW Cont If <br /> es 10 <br /> •nber of Tanks at facility 9e of Tanks(if available) IType of Tank teel Fbrgl ngl I Dual <br /> TANK HISTORY <br /> os Tank tested? as o ailed precision test ? es o If yes, give date(s) <br /> as a repair made to the tank system? esN0 f yes, what was repaired7 <br /> ns repair done under inspecCi on7 es o arc soil samples analyzed?=Zed? TXE PH•G PH-0 b/E00 <br /> ype of failure/discharge atastrophic Long-term Leakage verfill I nown cher: <br /> REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es0 epth to Ground Water of/Year verage Annual Precipitation a 4 10.25 <br /> n•Site 'Jell(s) es o umber 3 Type Irr I bom I ub <br /> S core S care 5 core <br /> istance to Well(s) from Tank ft; ft; Fc 0 pts C pts C PCs <br /> 0 f 0 if 0 if <br /> R mdition R condition R ondicion <br /> Site Feature Leaching Potential Analysis �is met E is met E is met <br /> inimum Depth to groundwater from the Soil Saeple (feet) >100 1-100 25-50\1 <br /> ractures in subsurface Capplies to foothills or mountain areas) w None Unknown resent <br /> verage Annual Precipitation (inches) xxxx <10 9 10-25 xxxxxx 26-40\2 <br /> nn•Made conduits which increase vertical migration <br /> 1 leachate (i.e., septic systems, water wells, porx:s) None Unknown resent <br /> nioue site features: Recharge area, coarse soil, nearby wells. At Least are than <br /> xxxx None one one <br /> COLUMN TOTALS»>iOTAL POINTS <br /> ample Result: (B i X OR E) RANGE OF TOTAL <br /> POINTS 9 pcs or more I i. 41 48cp4s 40 pts or less <br /> ,`Z �� B 1 i X E 3 T X E <br /> MAXIMUM ALLOWABLE 3-i•X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. HA\3 <br /> ample Result: SOLINE1000 100 10 <br /> C I AXIMUM ALLOWABLE TPN LEVELS (PPM) <br /> U M TPN e'y IESEL 1 10,000 1000 100 <br /> OCTNOTES: >*•If docunenced soil 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 <:5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX8E are rot applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECCMMENOATION/CONCLUSION <br /> 1• Are 3TX 4 E or TPN Concentrati > Allowable Levels Ycs o <br /> 2. Recommend Site Closure es O I If Yes, Refer to Site Mitigation for Evaluation <br /> 1. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES NO <br /> )ATE REFERRED A!E CLOSURE LETTER MAILED <br /> ':4L'JA1C✓ I <br />