Laserfiche WebLink
SAN JOAOUIk iTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HL,%.—, DIVISION <br /> I. GST WORKSHEET FOR SITE CLOSURE EVALUATION ATE 7 <br /> E OF FACILITYSWEEPS CODE <br /> DRESS TANK ID # 39' 7,06,S o ) <br /> TANK SIZE UEL TYPE <br /> II. GENERAL SITE HISTORY <br /> Is permit current? es o ermit # - acitity Status Code IDoc.Soit/GW Cont es o <br /> umber of Tanks at facilityge of Tanks(if available) ype of Tank teel Fbrgl ngl Duat <br /> III. TANK HISTORY <br /> as Tank tested? es o ailed precision test ? es o If yes, give dates) <br /> Jas a repair made to the tank system?IYes No JIf yes, what was repaired? <br /> Jas repair done under inspection? es I No ere soil samples analyzed? es o TXE I PH-G I IrPH-D b/EDB <br /> ype of failure/discharge atastrophic ong-term leakage verfitl own I lother: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received eso epth to Ground Water 52 of/Year Sf ;�'(o verage Annual Precipitation <br /> -Site Wetl(s) es o umber & Type Irr om ub <br /> S score S Score S core <br /> istance to Welt(s) from Tank I ft; ft; ft C 10 pts C 9 pts C pts <br /> 0 if 0 if 0 f <br /> R condition R condition R condition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) .SZ—g;-ZH TT >100 1-100 S 25-50 1 <br /> Fractures in subsurface (applies to foothills or mountain areas) , / I0 None Unknown resent <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxx 26-40\2 <br /> an-Made conduits which increase vertical mrigration <br /> f Leachate (i.e., septic systems, water wells, ponds) / D None Unknown resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxxxxx None 9 one one <br /> COLUMN TOTALS»>TOTAL POINTS Z v + <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS f9 pts or more 41 - 48 pts \ 40 pts or less <br /> 1 <br /> 73 B T X E % B T X E <br /> T` <br /> X'�-7 KAXIML14 ALICUABLE 8-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. 1 NAS <br /> Sample Result: SOLINE 1000 100 10 <br /> all e��dliU IMUM ALLOWABLE TPH LEVELS (PPM) / <br /> ' 7-7 TPH IESEL 10,000 1000 100 <br /> OOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete theme teaching potential <br /> analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br /> L If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. <br /> L If precipitation is > 40 inches, score 0 points. <br /> L Levels for 8TX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION , <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels Yes o <br /> 2. Recommend Site Closure es o �/ If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> ONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION fES O <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF J <br /> VALUATOR <br /> EN 23 80 (UGTWKSHTk5/90 <br />