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HEA SERV] LTX CES/ENVIRONMENTAL HEALTH DIVISION SAN JOAOUIN COUNTY PUBLIC GATE UGST WORKSKEET FOR SITE CLOSURE EVALUATION 1, SWEEPS CODE NAME OF FACILITY TANK 1D t: - ADDRESS TANK 512E FUEL TYPE moi+ II. GENERAL SITE HISTORYFacility Status Ccde Doc.SoiL/GW Cont Yes No Is permit current? Yes No Permit a: - Age of 7anks(if available) Type of Tank Steel FbrgL Sngl Dual Number of Tanks at facility Ill. TANK HISTORY reIf yes, give date(s) Was Tank tested? Yes No Failed precision test 7 Yes No Was a repair made to the tank system? Yes No If yes, what was repaired? Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE iPH-GI TPH-D Pb/EDS Type of failure/discharge catastrophic long-term Leakage overfill lunknown other: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING eOTEg eTAAL ANLALYSIS Precipitation A= 14 10-25 soil Samples Received Yes No Depth to GrGurd Water Ref/Year Pub S Score S Score Number 8 Type Irr Dopa S Score On-Site WeIL(s) Yes No C 10 pts C 9 pis C 5 pis _ft; ft: ft O if 0 if Distance to Well(s) from Tank O 'f condition R condition R condition R E is met E is met E is met V. Site Feature - Leaching Potential Analysis >100 51-100 25-50\1 Minimum Depth to groundwater from the Soil Sample (feet) None Unknown Present Fractures in subsurface (applies to foothills or mountain areas) 9 10-25 xxxxxxx 26-40\2 xxxxxx <10 Average Annual Precipitation (inches) rationNone Unknown Present Man-Made conduits which increase ,erticalater wells, ponds) of leachate (i.e., se Y At Leastl More than xxxxxx None one one Unique site features: Recharge area, coarse soil, nearby wells. COLUMN TOTALS»,TOTAL POINTS 41 - 48 pts 40 pts or Less RANGE OF TOTAL POINTS 49 pts or more Sample Result: (B T X OR E) B T X E B T X E NA\3 MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 3 100 1 1 10 GASOLINE 1000 Sample Result: 1000 100 MAXIMUM ALLOWABLE TPR LEVELS (PPM) DIESEL 10,000 TPH p otenti al �— FOOTNOTES, •'*If documented soil and/or ground water contamination is resent, do not complete the leaching p Intl If depth <=5 ft., do not use table. analysis. (i•e•, site is currently on UGT Contamination Lis[ for soil or ground water. \1 If depth is > 5 ft. and < 25 ft., score 0 poi PP"� (gasoline) or 100 ppm (diesel). \2 If precipitation is > 40 inches, score 0 points. \3 Levels for ationTX&E are not appl icabLe at a TPH concentration of 10 <9 VI. STAFF RECOMMENDATION/CONCLUSION 1. Are BTX 8 E or TPH Concentrations > Allowable Levels *Yes No 2. Re,o,,and Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation VIinr! ON - TO BE COMPLETED BY A SUPERVISOR/SENIOR F RECOMMENDATION FOR CLOSURE YES NO REFERRED TO S[TE MITIGATION FOS EVALUATION YEs NO/ DATE CLOSURE LETTER MAILED/ EH 23 80 (UGTWKSHT)\5/90