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0 0 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I.FACILITYRANK INFORMATION DATE: I April 4,20U SITF/FI ACILITY NAME: I SJ RTD STATUS CODE: 150 ADDRESS: 1533 Lindsay CITY: I Stockton FA#: FA0003749 PR#: PR0531158 TANK# 1 39-0115814 TANK SIZE: 6,000 allon FUEL TYPE: New Oil (RTD & samples refer UST as T7) II. GENERAL SITE HISTORY Is Permit Current? Yes Documented Soil/GW Contamination?'** No Number of Tanks at Facility 8 Age of Tanks (if available) 22 years Type of Tank : Fiberglass III TANW NIQTr1RV Was Tank Tested? ❑ Yes x No Failed Testing? L3Yes x No If Yes, Provide Dates: Was Tank System Repaired? ❑ Yes ❑ No If Yes, Describe Repair: Was Repair Done Under Permit? ❑ Yes ❑ No Were Soil Samples Analyzed? x Yes ❑ No TBTE7 TPH-D, TPH-k, TPH-mo Type of Failure/Discharge: ❑ Catastrophic ❑ Long-term Leak ❑ Overfill ❑ Unknown ❑ Other ni OCRAn 1 WQTn0V nh MI. Soil Samples Received? ❑ Yes ❑ No Seasonal High Depth to GW 33 ft bgs Year/ Reference 1 1983 Onsite and/or Nearby Well(s)? Yes ❑ Irrigation: # Distance to Tank _ ft C Score 10 C Score 9 ❑ Domestic: # Distance to Tank _ ft 0 points if 0 points if 0 Score 5 points if ❑ Public: # Distance to Tank ft R condition is R condition is R condition is met E met E met E V. SITE FEATURE— LEACHING POTENTIAL ANALYSIS 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 9 Unknown Present i.e. septic sstems, water wells, ponds): transite waterline, gas line Unique Site Features: Recharge Area, Coarse Soil (coarse sands, 10 None At Least One More Than One gravels), nearby wells Column Totals Total Points 20 + 18 + 5 = 43 Sample Results for BTEX: Range of Total Points 49 Points or More 41— 48 Points 40 Points or Less ND @ 0.005 mg/kg) Maximum Allowable BTEX B T E X B I T E X 1 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 ND @ 5 mg/kg for diesel Allowable TPH Diesel 10,000 1,000 100 Levels m 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). 1 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 for TPH-Diesel. VI. STAFF RECOMMENDATIONI REFERRAL/ REVIEW 1. Are BTEX or TPH Concentrations > Allowable Levels? No 2. If No, Is Site Closure Recommended? Yes Completed By: Jeffrey Wong Date Referred to Site Mitigation Unit for Final Actiont Reviewed By: Concur with Staff RecommendationLZ�s ❑ No Date Closure Letter Mailed tAll Cases are Referred to Site Mitgaf on for Final Action EH 23-0080 (Rev 11/14/08)