Laserfiche WebLink
SAN JOACUTATY PUBLIC HEALTH SERVICES/ENVIRONMENTAL DIVISION ATE <br /> L UGST WORKSHEET FOR SITE CLOSURE EVALUATION <br /> nME OF FACILITY 0 1 Q �ockK o WEEPS COOS 2 <br /> DORESS 2�Q (,L.)�1,�(n l.� - `' {� ANK 10 # C./ <br /> [ARK SIZE 25 <br /> '✓A�UEL TYPE <br /> 11. GENERAL SITE HISTORY <br /> Is permit current7 es o ermit # - acility status Cade I f oe.So' /GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) LV <br /> ✓vj :- ype of Tank teel Fbrgl ngl Dual <br /> 111. TANK HISTORY <br /> ms Tank tested? as o ailed precis//i on test 7 es o if yes, give date(s) <br /> Was a repair made to the tank system? ��e11s Fmo f yes, what was repaired? <br /> Was repair time under inspec ion? es N ere soil samples analyzed? as o TXE PH-G PH-0 b/EDB <br /> Type of failure/discharge a a c ophic long-term leakage verfiLL nknown cher: <br /> 1V• REMOVAL HISTORY (ATTACH INSP CTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es o epth to Ground Nater 1py- of/Year r UverageAmuatl Precipitation = G 045 <br /> -Site Wallis) es a ber d Type trr cm ub <br /> S ore S core <br /> istance to Wells) from lank t; ft; ft C pts C pts <br /> 0 f 0 'f <br /> R tdi[ion R ondi tion <br /> Site Feature - Leaching Potential Analysis E s mei: E 's met <br /> inimun Depth to groundwater frac the Soil Sail feet 11fS ) y 1-100 25.5011 <br /> ractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) uxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits uihich increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown 'resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least ore than <br /> xxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS + ' <br /> ample ResuLt: (B TT,X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> TX E <br /> J! Tt m&Q•J7 5 HA%INCH ALLOWABLE B•T•%-E LEVELS (PPM) 7 50 50 50 .3 .3 1. 1. NA\3 <br /> ample Result: <br /> ASOLINE 1000 100 10 <br /> NAXI NJH ALLWABLE TPN LEVELS (PPM) <br /> L TPH IESEL 10,000 1000 100 <br /> OOTHOTES: "<If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> anatysis. (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 BTXBE are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECCFMENOATION/CONCLUSION <br /> 1. Are BT% $ E or TPH Concentrations > Alto Le Levels Yes o <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation (or Evaluation <br /> Vil. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> -ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED IT <br /> ATE CLOSURE LETTER MAILED / <br /> 1AME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />