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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITYITANK INFORMATION DATE: April 4, 2014 SITE/FACILITY NAME: j SJ RTD STATUS CODE: 1 50 ADDRESS: 1533 Lindsay CITY: I Stockton FA#: FA0003749 PR#: PR0531158 TANK# 39-0115819,39-0115820 (split TANK SIZE: 1,000 11,000 gallon FUEL TYPE: Regular /Transmission Oil s lit tank (RTD & samples refer as T5 & T6) 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 year 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? E3 Yes E3 No Were Soil Samples Analyzed? x Yes E3 No T5: BTEX, TPH-G, 5 Oxy, -kTPDCA/EDB T6: BTEX, TPH-d, TPH-k,, TPH-mo Type of Failure/Discharge: ❑ Catastrophic ❑ Long-term Leak ❑ Overfill ❑ Unknown ❑ Other R��:7dd,f�V/d �:Ir.9 f�1:1//S:&L7771rd Soil Samples Received? ❑ Yes ❑ No Seasonal High Depth to GW 33 ft bgs Year/ Reference 1983 Onsite and/or Nearby Well(s)? Yes ❑ Irrigation: # Distance to Tank ft C Score 10 C Score 9 C ❑ Domestic: # Distance to Tank ft 0 points if 0 points if 0 Score 5 points if ❑ Public: # Distance to Tank ft R E condition is met R E condition is met R E 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 None 9 Unknown Present .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 NO @ 0.005 mg/kg) Maximum Allowable BTEX B T I E X B T E 1 X N/A3 Levels m 1.0 50 50 50 0.3 0.3 1.0 1.0 Sample Results for TPH: Maximum I Gasoline 1,000 100 10 NO @ 1 mg/kg for gas Allowable TPH ND @ 5mg/kg for diesel 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). 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 RECOMMENDATION/ REFERRALI 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 p Reviewed By: Concur with Staff Recommendatio s ❑ No Date Closure Letter Maile tAII Cases are Referred to Site Mitigation for Final Action EH 23-0080 (Rev 11/14/08)