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TY PUBLIC <br />LTH <br />RCNMENTAL <br />1 SAN d0A0UI ST WORKSHEETA-FOR SITE CLOSURE( EVALUATION DIVISION DATE <br />�6� <br />NAME OF FACILITY � C-ewiti-�'�.5,_ 1. SWEEPS CDOEI ,3 <br />ADDRESS( 'Ag n % � ' , a ` ! D -`-' /�.. _. -.� G'�//. ITANK ID 91.'� 4 - I —7 <br />ITANK SIZE 16 d OU IFUEL TYPE <br />II. GENESTORY <br />permit <br />current? <br />IYes <br />l <br />No <br />(Average Annual Precipitation) <br />(Permit k <br />Nol lIf <br />- <br />Facility Status Codel <br />1DOC.Sail/GW <br />Cont <br />IYesl <br />BTXEI 1TPH-Gl 1TPH-DI <br />lNa <br />tuber of <br />Tanks at <br />facility) <br />(overfill) <br />(Age of <br />Tanks(if available) <br />(Type of Tankisteell <br />1Fbrgll <br />Sngl <br />Dual <br />III. TANK HISTORY <br />Was Tank tested? <br />Yes <br />Nol !Depth to Ground Water) <br />No <br />)Failed precision test ?Iyes <br />(Average Annual Precipitation) <br />A-114 <br />Nol lIf <br />yes, give carets) <br />On -Site WeLL(s)IYes <br />Was a repair made to the tank system?IYes NoI IIf yes, what was repaired? <br />(Was repair done under inspecticn?IYes1 Nol Were soil samples analyzed?( YesI (NoI <br />Number 8 Type <br />BTXEI 1TPH-Gl 1TPH-DI <br />Pb/EDB( <br />Type of failure/discharge) <br />)catastrophic) hang -term leakage) <br />(overfill) <br />(unknown) <br />other: <br />IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br />,Soil Samples .ReceivedlYes <br />FOR CLOSURE <br />Nol !Depth to Ground Water) <br />)Ref/Year <br />YESI INOI <br />(Average Annual Precipitation) <br />A-114 <br />DATE .REF'cRRED <br />110-25 <br />On -Site WeLL(s)IYes <br />DATE CLOSURE LETTER MAILED( <br />No <br />Number 8 Type <br />Irr <br />Dom l <br />Puol <br />S <br />C <br />ScoreS <br />10 pts <br />C <br />Score <br />9 pcs <br />S <br />C <br />Score <br />5 pis <br />Distance to Well(s) from Tank ft; ft; ft <br />0 <br />if <br />0 <br />if <br />0 <br />if <br />R <br />condition <br />is met <br />.R <br />= <br />condition <br />is met <br />R <br />E <br />condition <br />is mac <br />V. Site Feature - Leaching Potential Analysist <br />Minimum Depth to groundwater from the Soil Sample (feet) <br />>100 <br />! <br />151-100 <br />1 1 25-50\1 <br />Fractures in subsurface (applies to foothills or mountain areas) <br />I None <br />I <br />I Unknown <br />!Present <br />,Average Annual Precipitation (inches) <br />xxxxazl <br /><10 <br />9 <br />10-25 <br />lxxxxxxxl <br />26-40\2 <br />i <br />(Man -Made conduits which increase vertical migration <br />I <br />lof teachate (i.e., septic systems, water wells, ponds) <br />None <br />Unknown <br />(Present <br />(Unique site features: Recharge area,, coarse sail, nearby welts. <br />At least <br />More than <br />! J 7-'� — J?;f;. _ <br />xxxxxx <br />None <br />one <br />one <br />r . E = lj/C�l, <br />COLUMN TOTAL >TOT POINTS <br />Sample Result: (S T X OR E) <br />RANGE OF TOTAL POINTS <br />49 pts or more I <br />41 - 4a pts I <br />40 pts or Less <br />1.3 E A,1J D <br />'r 3 k rV 1) <br />MAXIMUM ALLOWABLE 3 -T -X -E LEVELS (PPM) <br />1B 50 <br />50I 50 <br />.3 .3 1. 1. <br />NA\3 <br />Sample - ResuL ' tJ <br />GASOLINE, <br />MAXIMUM ALLOWABLE TPN LEVELS (PPM) <br />00 <br />111 <br />70,000 <br />1100 <br />100 <br />DIESEL <br />FOOTNOTES: —If documented soil and/or ground water contamination is present, do not complete the teaching potential <br />analysis. (i.e., site is cUrrentty on UGT Contamination List for soil or ground water.) <br />\1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth c5 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 TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br />VI. STAFF RECOMMENDATION/CONCLUSION-j^ �, <br />1. Are BTX 8 E or TPH Concentrations > Allowable Levels -YesI ,No i <br />2- Recommend Site Closure) Yes No If Yes, Refer to Site Mitigation for Evaluation) <br />VII. .REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SE410R <br />CCNCUR WITH STAFF RECOMMENDATION <br />FOR CLOSURE <br />YES INOI <br />(REFERRED TO SITE MITIGATION FOR EVALUATION <br />YESI INOI <br />I <br />DATE .REF'cRRED <br />/ / <br />DATE CLOSURE LETTER MAILED( <br />NAME OF <br />EVALUATOR( <br />EH 23 80 (UGTWKSHT)\5/90 <br />