Laserfiche WebLink
r <br /> (n <br /> SAN JOAQUIN CG,:,.-r PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAj_.n 01VISION <br /> I UGST WORKSHEET FOR SITE CLOSURE EVALUATION <br /> Ri <br /> FACILITY ATE 1 <br /> EEPS CODE <br /> / <br /> S � , <br /> � ANK ID +J <br /> E UEL TYPE <br /> il. GENERAL SITE HISTORY <br /> Is permit current? es o ., <br /> ermit sraciti�y Status Code oe.5oil/GW Cant es <br /> umber of Tanks at facility ° <br /> ge of ranks(if available) ype of Tank ceet Fbrgl <br /> M. TANK HISTORY n9l Dual <br /> as Tank tested? es ° ailed precision test ? es <br /> o If Yes, give dace(5) ! <br /> as a repair made to the tank system? es No f yes, what was r I <br /> epaired? <br /> tis repair done under inspection? es ° ere soil samples analyzed? es Io TXE PN-G PH-D b/EDO <br /> vac of fai(ure/discharge aCaserophiclong-term leakage verfiltknown <br /> Cher: <br /> IV• REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA F1' LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es a epch to Ground Water � �� �� g <br /> of/Year vera a Annual Precipitation = 4 10-25 <br /> -Site uell(S) es o tanber & type Irr om <br /> uv <br /> pistance to well($) from Tank ftpS care S core S care <br /> ft; — —ft fl 0 pts C <br /> pts C pts <br /> 0 if 0 f <br /> Site Feature - Leaching Potential Anal R ondition R ondicion R ' <br /> ysts E [i's met E is met E s met onditian <br /> inirtwn Depth to groundwater from the Soil S <br /> ample (feet) >100 1-100 <br /> ractures in subsurface (applies to foothills or mountain areas) 0 2 <br /> Hone Unknown resent <br /> voyage Annual Precipitation (inches) -t <br /> xxxz <10 Q 10-25 xxxxxx 26-40\2 <br /> inn-Made Conduits which increase vertical migration <br /> f leachate ("e-, Septic systems, water wells, ,ponds) r <br /> None Unknown J resent <br /> )nique site features: Recharge area, coarse soil, nearby wells, <br /> EI �} At least are than <br /> xxxx Hone ` one <br /> one <br /> COLUMN TOTALS»>TOrAL POINTS <br /> z+mP(e 4esul t: (B t X OR E) t <br /> RANGE OF TOTAL POINTS 9 <br /> Pts" or more 41 4$ pts 40 pts or less <br /> MAXIMUM ALLOWABLE 3-T-X-I LEVELS (PPM) 4 T 50 50 3 € T X e <br />'am,ple Result: <br /> 3 .3 1. 1- NA\3 <br /> ' i SOLINE 000 <br /> f� Pry AXIMUM ALLOWABLE TAH LEVELS (PPM) i 100 10 <br /> -- IESEL 10000 1000 T00 <br />'OOTNOTES: ***If documented sail and/or ground water contamination is present, do not <br /> analysis- (i.e., site is currently on UGT Contamination list for so�lete the leaching potential <br /> 1i If depth is 5 ft. and < 25 ft., scare 0 points. o d ground water.) <br /> \2 If precipitation is > 40 inches, score 0 points. dept <'S ft., do not use table. <br /> 13 Levels for 8TX&E are not applicable at a TPN concentraci°n of 10 X m (gasoline) or 100 Ppm (diesel). <br /> STAFF RECOMMEMOATION/CONCLUSION <br /> 1. Arc BTX & E or TPH Concentrations > A(Lowabte Levels Yes oSC75-1 <br /> 2. Recommend Site Closure es o If Yes, Refer to site Mitigation for Evaluation <br /> REVIEW EVALUATION TO BE CCFaPLETED or A SUPERVISOR/SENIOR <br />;CMCUR WITH 'STAFF" RECOMMENOATICN FCR CLOSURE iE5 ! r <br /> €F_RREO <br /> + TO SITE HITIGATION FOR EVALUATION ES 0 <br /> ATE REFERRED ! / ATE CLOSURE LETTER MAILED # <br /> SME CF I ' <br /> VALUATOR C r <br /> H 23 80 (UGTWKSHT)\5/QO <br />:i <br /> 29 80 f <br />