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SAN JOACl1IN COUNTOBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH ION <br /> _ UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> NAME OF FACILITY WEEPS CODEL// <br /> nORESS oPj 5G^ ID 11 <br /> MANX SIZE ��-� UEL TYPE <br /> 4 <br /> - I. GENERAL SITE HISTORY <br /> Is permit current? as o ermit Al - stili[y Status Code `j�' oc.Stil/GW Cont esmbar of Tanks at facility f Tbrgl ngl FTT� <br /> !ll. TANK HISTORY <br /> as rank tested? as o ailed precision test 7 es o If yes, give da ate(s) <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> as repair done under inspection? as o / ere soil samples analyzed? es o ✓�CiIE PH-G PH-0 b/EDD <br /> ype of failure/discharge atastroph is long-term leakage vert ill nknown cher: <br /> V. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Ft it Samples Received as o epth to Ground Water Qom) of/Tear 6 ; verage Annual Precipitation = 4 0.25 <br /> -Site Wells) as o umber d Type Irr am ub <br /> istance to Wells) from TankS core S core S core <br /> ft; ft; ft C 0 pts C pts C pts <br /> O if 0 if 0 f <br /> R onditim R ondition R ondition <br /> Site Feature - Leaching Potential Analysis E 's met E is met E 's met <br /> inimxm Depth to grourcfwater from the Soil Sample (feet) >100 1-100 O 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Amuat Precipitation (inches) xxxx <10 9 10-25 xxxxxx 26.40\2 <br /> an-Rade conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None <br /> Unknown resent <br /> niWe site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> Xxxx None one one <br /> COLUMN TOTALS»>TOTAL POINTS . 7 + <br /> ample Result: (B T X OR E)gmb RANGE OF TOTAL POINTS 9 Fits or more 41 48 pts <br /> tJ - 40 pts or less <br /> a Loa /f OU <br /> j y /OU x /Sp OU B T X E B T X E <br /> MAXIMLH ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> ammpte Result: pp,b ASOLINE 1000 100 10 <br /> 2 Z 5 AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESEL 10,000 1000 100 <br /> IOOTNOTES: ***If docua,ented soil and/or ground water contaminatfon 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 8TX&E are net applicable at a TPH concentration of 10 ppm (gasoline) or 100 Fpm (diesel). <br /> STAFF RECCN4(ENOATION/CONCLUSION <br /> 1- Are RTX $ E or TPN Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure es o I X. If Yes, Refer to Site Mitigation for Evat nation <br /> I. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> -ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES I EFERRED TO SITE MITIGATION FOR EVALUATION ES <br /> ATE REFERRED / l 7 ATE CLOSURE LETTER MAILED <br /> NAME OF <br /> :VALUATOR <br /> CH 23 80 (UGTWKSHT)\5/90 <br />