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SAN JOAQUIN COUNTY ENVIRONMENTAL HEA• DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITY/TANK INFORMATION DATE: November 08,2011 SITE/FACILITY NAME: I Walgreens (Mailing: 151 E.3rd Avenue,San Mateo,CA 94401 STATUS CODE: 1 52 ADDRESS: Mariposa and Farmington CITY: I Stockton FA#: FA0021072 PR#: PR00536686 TANK# 39-0520437 TANK SIZE: 1000 FUEL TYPE: Unknown II. GENERAL SITE HISTORY Is Permit Current? ❑ Yes ❑ No Documented Soil/GW Contamination?"*" ❑ Yes ❑ No Number of Tanks at Facility 1 Age of Tanks(if available) Unknown Type of Tank®Steel ❑Fiberglass ❑Single ❑Dual III. TANK HISTORY Was Tank Tested? ❑ Yes ❑ No ft Failed Testing? ❑ Yes ❑ No If Yes, Provide Dates: Was Tank System Repaired? ❑ Yes ❑ No/✓/A If Yes,Describe Repair: Was Repair Done Under Permit? L3 Yes L3 No A(IA Were Soil Samples Analyzed?>(Yes ❑ No BTEX TPH G TPH-D LEAD os J8-OTHER 9 R M- I q Type of Failure/Discharge: ❑Catastrophic Long-term Leak ❑ Overfill ❑ Unknown ❑Other /+k S in 44 nK IV. REMOVAL HISTORY Attach File Soil Samples Received? ❑Yes ❑No Seasonal High Depth to GW 50 ft bgs Year/Reference 1983 Onsite and/or Nearby Well(s)? Yes(Monitoring Well, 171'bsg) ❑ Irrigation: # Distance to Tank_ ft Score 10 C Score 9 C ❑Domestic:# Distance to Tank ft C points if 0 points if 0 Score 5 points if 13 Public: # Distance to Tank ft R condition is R condition is R condition is met V. SITE FEATURE—LEACHING POTENTIAL ANALYSIS E met E met E Minimum Depth to Groundwater from Soil Sample(feet) >100 51 —100 5 25-501 Fractures in Subsurface(applies to foothill or mountain areas) 10 None Unknown Present Average Annual Precipitation(14 inches for SJC area) ------ <10 9 10-25 ---- 26-402_ Man-Made Conduits which Increase Vertical Migration None Unknown 5 Present .e.septic sstems,water wells,ponds): transite waterline, as line Unique Site Features:Recharge Area,Coarse Soil(coarse sands, None 9 At Least One More Than One gravels),nearby wells Column Totals Total Points 10 + 18 + 10 =38 Sample Results for BTEX: Range of Total Points 49 Points or More 41 —48 Points 40 Points or Less NO @ 0.001 mg/kg) Maximum Allowable BTEX B I T I E X B T E X N/A3 Levels m 1.0 50 50 50 0.3 0.3 1.0 1.0 Sample Results for TPH: Maximum Gasoline 1.000 100 10 9,300 ug/L(purgable)and 420 Allowable TPH mg/Kgmg/Kg Diesel extracted Levels m Diesel 10,000 1,000 100 Footnotes: "*If documented soil and/or groundwater contamination Is present,do not complete leaching potential analysis(i.e.site is already on the contamination list). I If depth is>5 feet and<25 feet score 0 points. If depth is<=5 feet,do not use table. 2 If precipitation is>40 inches,score 0 points. 3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH-Gasoline or 100 ppm forTPH-Diesel. VI. STAFF RECOMMENDATION/REFERRAL/REVIEW 1. Are BTEX or TPH Concentrations>Allowable Levels? Yes 2. 1�< Is Site Closure Recommended? yd y2 S Completed By: Jeffrey Wong Date Referred to Site Mitigation Unit for Final Actiont N/A Reviewed By: Concur with Staff Recommendation ❑Yes ❑No tAll Cases are Referred to Site Mitigation for Final Action Date Closure Letter Mailed EH 23-0080(Rev 11/14/08)