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(7 SAN JOADU N COUNTY "C HEALTH SERVICES/ENVIRCNMENTAL HEALTH 01"ISIOK'' q <br /> UGST EET FOR SITE CLOSURE EVALUAT:O4 - DATE j qL <br /> PS COB <br /> NAME OF FACILITY �€�-G-/�/GLS SWEEE /3�' <br /> ADORESSI TANK ID X '31 <br /> TANK SIZE FUEL TYPE Pr�J <br /> [I. GENERAL SITE HISTORY <br /> Is pe nnit current? Yes No Permit S Facility Status Code Dx.Soil/OW Cont Yes No <br /> INinber of Tanks at facility I Age of Tanks(if available) Type of Tank Steel Fbrgl Sngl Dual <br /> i[I. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test 7 Yes No if yes, give <br /> Was a repair made to the tank system? Yes No If yes, what was repaired? <br /> Was repair done under impecti on7 Yes No were soil saaples analyted? Yes No BTXE 7PH•G TPH-D Pb/EDB <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> I'1. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Sartples Received Yes No Depth to Ground Water �° Ref/Year Average Anrual P11recp <br /> iitation A= 14 10-25 <br /> on-site 'weLL(s) Yes No Nuaber & Type Irr Dan Pub S Score S Score S Score <br /> Distance to WeLL(s) from Tank ft; ft; ft C 10 pts C 9 pts CO Sfpts <br /> 0 if 0 if <br /> R condition R condition) R is dii Cion <br /> Feature Leaching Potential Ara lysis <br /> E is met E is met E <br /> >100 51.100 0 25-50\1 <br /> (Mini mm Oepth to groundwater from the Soil S�P le (feet) Zv b <br /> Fractures in subsurface (applies to foothills or mountain areas) <br /> None Unknown Present <br /> xxxxxx <10 9 10-25 XXXXXXX 26-40\2 <br /> Average Annual Precipitation (inches) CJI <br /> Man-Made conduits which increase vertical migration None - 1 USW Present <br /> of Leachate (i.e., septic systems, water wells, ponds) <br /> At least More than <br /> Unique site features: Recharge area, coarse soil, nearby wells. xxxxxx None one one <br /> COLUMN TOTALS <br /> »>TOTAL POINTS <br /> Sample Result: (a T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 48 pts 40 pts or less <br /> ,8'ri.0.)RL= �3/ynE�/1'SPV� B T X E 8 T X E <br /> ej- �. .. : .oo NA\3 <br /> MAXIMUM ALLOWABLE B-T-X•E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. <br /> GASOLINE 1000 100 10 <br /> Sample Result: <br /> MAXIMUM ALLOWABLE TPN LEVELS (PPM) 100 <br /> rDIESEL 10,000 1000 <br /> �•*If docurwrted soil and/or ground water contamination is present, do not conplete the leaching po <br /> FOOTNOTES: tential <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., scare 0 points. If depth 4=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppa (gasoline) or 100 ppm (diesel). <br /> V[. STAFF RECCMMEHDAT ION/CONCLUSION <br /> 1. Are SIX & E or TPH Concentrations > Allowable Levels *Yes No74i(/A �j(�O <br /> mmef/�/ <br /> 2. Recommend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation '( /JJ�*'r—" b <br /> VII. REVIEW EVALUATION • TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> kEVALUA!�TORT' <br /> WISTAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITI WTION FOR EVALUATION YES NO <br /> ED DATE CLOSURE LETTER MAILED <br /> EH 23 30 (UGTWKSHT)\5/90 <br />