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! • SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITY/TANK INFORMATION DATE: I April4, 2014 SITEIFACILITY NAME: I SJ RTD STATUS CODE: 1 50 ADDRESS: 1533 Lindsay CITY: I Stockton FA#: FA0003749 PR#: PRO531158 TANK # 39.0115815,-16,-17,-18 4 USTs TANK SIZE: 20,000 gallon each FUEL TYPE: Diesel I (RTD & samples refer as T1 — T4) Is Permit Current? Yes I Documented Soil/GW Contamination?*** No Number of Tanks at Facility 8 Age of Tanks (if available) 22 years Type of Tank : Fiberglass III. TANK HISTORY Was Tank Tested? ❑ Yes x No Failed Testing? ❑ Yes 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 BTEX, TPH-D Type of Failure/Discharge: ❑ Catastrophic ❑ Long-term Leak ❑ Overfill ❑ Unknown ❑ Other ■r,��:t�r,lav�w:Iry�.rr�c�i�raamn Soil Samples Received? ❑ Yes ❑ No Seasonal High Depth to GW 33 ft bgs Year/ Reference 1983 Onsite and/or Nearby Well(s)? Yes L3 Irrigation: # Distance to Tank ft ❑ Domestic: # Distance to Tank ft ❑ Public: # Distance to Tank It C 0 R E Score 10 points if condition is met C 0 R E Score 9 points if condition is met C 0 R E Score 5 points if condition is met 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 i.e. septic sstems, water wells, ponds): transite waterline, gas line ---- --- None 9 Unknown Present Unique Site Features: Recharge Area, Coarse Soil (coarse sands, gravels), nearby wells 10 None At Least One More Than One Column Totals Total Points 20 + 18 + 5 = 43 Sample Results for BTEX: ND @ 0.005 mg/kg) Range of Total Points 49 Points or More 41 — 48 Points 40 Points or Less Maximum Allowable BTEX Levels m B 1.0 T 50 I E 50 X 50 B 0.3 T 0.3 E 1.0 I X 1.0 N/A3 Sample Results for TPH: ND @ 5 mg/kg for diesel Maximum Allowable TPH Levels m I Gasoline 1,000 100 10 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 more 0 points. If depth is <=5 feet do not use table. 2 If precipitation is> 40 inches, scare 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 RECOMMENDATION/ 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 Recommendation6;l ❑ No Date Closure Letter Mailed fAII Cases are Referred to Site Mitigation for Final Action EH 23-0080 (Rev 11/14/08)