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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITY/TANK INFORMATION DATE: 1 12/23/2014 SITEIFACILITY NAME: I Caltrans STATUS CODE: 1 50 ADDRESS: 19107 Highway 26 CITY: I Stockton FA#: FA0022676 PR#: PRO539625 TANK# 39 20768 TANK SIZE: 400 gallon FUEL TYPE: fuel II. GENERAL SITE HISTORY Is Permit Current? Yes Documented Soil/GW Contamination?'" No Number of Tanks at Facility 1 Age of Tanks(if available) Unknown Type of Tank:Steel Ill. TANK HISTORY Was Tank Tested? ❑ Yes x No Failed Testing? ❑ Yes x No If Yes,Provide Dates: Was Tank System Repaired? ❑ Yes x No If Yes, Describe Repair: Was Repair Done Under Permit? ❑Yes x No I Were Soil Samples Analyzed? x Yes ❑ No BTEX TPH-9 TPH-d MTBE Type of Failure/Discharge: ❑Catastrophic ❑Long-term Leak ❑ Overfill ❑ Unknown ❑Other IV. REMOVAL HISTORY Attach File Soil Samples Received? X Yes ❑ No Seasonal High Depth to GW _129/144_ft bgs Year/Reference 2012/2014 Onsite and/or Nearby Wallis)? No L3 Irrigation: # Distance to Tank ft Score 10 Score 9 C El Domestic:# Distance to Tank ft C points if C points if O Score 5 points if L3 Public: # Distance to Tank it 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) 10 >100 51-100 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): transits waterline,gas line Unique Site Features:Recharge Area,Coarse Soil(coarse sands, 10 None At Least One More Than One ravels),nearby wells Column Totals Total Points 30 + 18 1 + =48 Sample Results for BTEX: Range of Total Points 49 Points or More 41 –48 Points 40 Points or Less ND Benzene;6.9mg/kg T;8.1 mg/kg E; 45.0 mp-X;21 mg/kg Maximum Allowable BTEX B T E X B X N/A3 o-X Levels(ppm) 1.0 50 50 50 0.3 0.3 1.0 1.0 Sample Results for TPH: Maximum Gasoline 1,000 100 10 1,300mg/kg Gas;610 mg/kg Allowable TPH 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/REFERRAL/REVIEW IV& 1. Are BTEX or TPH Concentrations>Allowable Levels? No'V07 1 2. If No, Is Site Closure Recommended? Yes Completed By: Jeffrey Wong Date Referred to Site Mitigation Unit for Final Acliont Reviewed By: dd &i Concur with Staff Recommendation es ❑ No Date Closure Letter Mailed 1AII Cases are Referred to Site Mitigation for final Action EH 23-0080(Rev 11/14/08)