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SAN JOAQUIN CCli"TY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE41LH DIVISION <br /> I. 'ST WORKSHEET FOR SITE CLOSURE EVALUATION DATE , .— <br /> NAME OF FACILITY <br /> uJ-Yl ga T '_ SWEEPS CODE <br /> AOORESSl Y' <br /> r <br /> TANK SIZE / �(j�) FUEL TYPE <br /> 11. GENERAL SITE HISTORY T&4LL_6&aSee4 <br /> rrr <br /> Is permit current? Yes No Permit B - Facility Status Code r"td Doc. oil/GW Cont Yes No <br /> Number of Tanks at facility —3 Age of Tanks(if available) Type of Tank SteelFbrgl Sngt Dual <br /> IIT. TANK HISTORY A.i <br /> Was Tank tested? Yes No Failed precision test 7 Yesl No If yes, give date(s) <br /> Was a repair made to the tank system7Yes No If yes, what was repaired? <br /> Was repair done under inspection? Yes No Were soil samples analyzed? Yes No BTXE TPH-G TPH-OI Pb/ED8 <br /> Type of failure/discharge catastrophic long-term leakage) overfill unknown other: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground Water .� Ref/Year)S ' Average at Prec ip itation l A=114 10-25 <br /> On-Site WeLL(S) Yes No Number 8 Type Irr Dam Pub <br /> S Score S Score 5 Score <br /> Distance to WeIL(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis 'c is met E is met E is met <br /> Minimntn Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10.25 xxxz xx j 26-40\2 <br /> I Man-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water wells, ponds) None Unknown Present <br /> Unique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS . + <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> B T % E B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000 I 100 10 <br /> MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH DIESEL 10,000 1000 100 <br /> FOOTNOTES: --If documented soil 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 STXBE are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VT. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are 8TX 3 E or TPH Concentrations > Allowable Levels IrYes No <br /> 2. Recommend Site Closure Yes NoI rif Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO 3E COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSUREIYES NG! REFERRED TO SITE MITIGATION FOR EVALUATTONIYESI INOI <br /> DATE .REFERRED DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 SO (UGTWKSHT)\5/90 <br />