Laserfiche WebLink
SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONME4TAL HEAVISION <br /> I• UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE / Cr' <br /> ANE OF FACILITY WEEPS CODE <br /> ADDRESS ANK ID e <br /> TANK SIZE IFUEL TYPE <br /> II. GENERAL SITE HISTORY ,0/ <br /> Is permit current? es o ermit q acility Status Code oc.Soil/GW Cont es o <br /> umber of Tanks at facility ge of ianks(if available) ype of Tank teal Fbrgl ngl I Dual <br /> III. TANK HISTORY <br /> ,is Tank tested7 es o ailed precision test ? es o If yes, give date(s) <br /> as a repair made to the tank system? eS No f yes, what was repaired7 <br /> ms repair done under inspection? es 40 ere soil samples analyzed? es 10 TXE PH-G PH-D b/EDO <br /> ype of failure/discharge atastrophic long-term leakage verfill nknown cher: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Foil Samples Received es o epth to Ground Water — of/Year verage Annual Precipitation 4 10.25 <br /> -Site Wells) es o umber 8 Type Irr om ub <br /> S core S core S core <br /> istance to Wells) from Tank ft; ft; ft C 0 pts 9 pts C <br /> pts <br /> 0 'f 0 if 0 if <br /> R ondition R condition R ondition <br /> V. Site Feature Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet)�b_('S >100 1.100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) a Nate Unknown resent <br /> verage Annual Precipitation (inches) xxzxx <10 9 10.25 xxxxxxx 26.40\2 <br /> an-Made conduits which increase Vertical migration �> <br /> f leachate (i.e., septic systems, water wells, ponds) '�V None Unknown resent <br /> )nique site features: Recharge area, coarse soil, nearby wells. q At Least lore than <br /> xxxxx None 7 one one <br /> COLUMN TOTALS»>TOTAL POINTS <br /> ample Result: (S T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 • 48 pts 40 pts or less <br /> X oe ye 6 tO PPb G T X E 8 T E <br /> MAXIMUM ALLOWABLE 0•T-X•E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sampt Result; �� »^ AXIMUM ALLOWABLE TPH LEVELS (PPM) ASOLTNE 1000 100 10 <br /> IESEL 10,000 1000 100 <br /> FOOTNOTES: >•-If documented sail and/or ground water contamination 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 not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (dieset). <br /> VI. STAFF RECOMMENOATION/CONCLUSION <br /> t, Are BTX 8 E or TPH Concentrations > Allowable Levels FYes F o <br /> I2. Recommend Site Closure Yes I L'+o i If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION . TO BE CCMPLETEO BY A SUPERVISOR/SENIOR <br /> .ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 Ef ERRED TO SITE MITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF <br /> -VALUATOR � > <br /> EN 23 80 (UGTWKSHT)\5/90 <br /> .x 29 80 <br />