Laserfiche WebLink
SAM JOAQUIN COIAW AALIC HEALTH SERVICES/ENVIROMMENTAL HEAL 43110M <br /> MT WORKSHEET FOR SITE CLOSURE EVALUATICM ATE <br /> .4"S OF FACILITY AA , :::REPS CODEZ <br /> Rees sj ANK IS S <br /> ANXK SIZE L t <br /> It. GEM111RAL SITE HISTORY <br /> 9 6 mit currant? es o its anility Status Code oc.Soll/Gw Cont Vm <br /> Ift <br /> of Yanks at facility ge of Taaks(if avatlobta) ype of Taal: reel t l Owl <br /> 111. TANK HISTORY <br /> Tank tested? es ailed precision test ? ss o f yes. gi��to(s) <br /> a repair ride to file tank systm? es No 11f yes, what was repaired? <br /> s repair done under inspecClanT es re soil saWtes analyzed? ee MO T—m PH-G I P11-0 I me <br /> ype of faiture/dtseharse atastrophie am-term leakage fitl then: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> it Samples Received as epch to Ground We tar 1,0 of car age Armial Precipitation ■ 4 0-25 <br /> -Site iaeii(s) es o i Type tar am <br /> S e S re S ore <br /> istanee to Welt(s) from TaMt ft; ft; ft C 0 pts C pts C pts <br /> 0 f 0 if 0 f <br /> R ition R ondition R ition <br /> Site Feature - Leaching Potential Analysis E s out E a net e s met <br /> iniatae Depth to groundwater from the Soil Sample (fest) 3,100 1-100 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) b Nae unknowrn resent <br /> verege Annual Precipitation (inches) KXX= CIO 9 10-25 xuxxxx 261-40\2 <br /> Made eonckits which increase vertical migration q <br /> f leachate (i.a., septic systems, water watts, pard*) None ! Unknown resent <br /> Ini" site features: RadmoW arena, coarse soli, nearby watts. At Least 4ore thou <br /> Mone one one <br /> COLOW TOTALS3,s3,TOTAL POINTS /D + / O • <br /> t Result: (B T X OR E) RANGE OF TOTAL PO[MTS 9 pts or Wore 41 - 68 pts 40 pts or 2-1s <br /> T yit I 1� Pr B T X E B f X E <br /> k qn MAXIMUM ALLOWABLE B-T-X-e LEVELS (PPM) 1 50 SO 50 .3 3 1. 1. XA\3 <br /> Samipte Result: IRIE 1000 100 10 <br /> 4AXIMM ALLOWABLE TPH LEVELS (PPM) <br /> 0Ob Im [ESEL 101000 1000 100 <br /> FOOTNOTES: —if doeunmited soil and/or ground water eontamiracion is presenc, do not complete the leaching potential <br /> analysis. (i.e.. site is currently an UOT -Contmainstion List for soil or groumd water.) <br /> \1 if depth is s 3 ft. and t 25 ft.. more 0 points: If depth od ft., do not use table. <br /> \2 if precipitation is s 40 inches, scare 0 points. <br /> \3 Levels for 611AU are nst applicable at a TPN commmtration of 10 ppm (gaaotine) or 100 on (diesel). <br /> V1. STAFF RE00141gB4AT101tlCoNWBSBON <br /> I. Are CBT1I 9 E or TION Concentration* s Allowable Levets <br /> 2. Recoawrd Site Closurees f Yes, Refer to mat Mitigation for Evaluation -z7 <br /> = <br />'V:I. REVIEW EVALUATION - TO SE COMPLETES BY A SUPERVtSM/S11*1011 <br /> WITH STAFF RECOMMENDATION FOR CLOSURS ES EFERRED TO SITE MITIGATION FOR EVALUATION ES <br /> AYE REFERRED / ! ATE CLOSURE LETTER MAILED <br /> : 49. or <br /> JALJATOR <br /> EN 23.E <br />