Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> 1' UGST WORKSHEET FOR SITE CLOSURE EVALUATION P <br /> AME OF FACILITY l <br /> WEEPS CODE <br /> DRESS COQV l U _ <br /> AUK ID # <br /> ANK SIZE I IFUEL TYPE <br /> II. GENERAL SITE HISTORY <br /> Is permit current? es o ermit # - acility Status Code I oc.Soil/GW Cont es o <br /> umber of Tanks at facility ge of Tanks(if available) JT <br /> ype of Tank teel Fbrgl ngl Dual <br /> III. TANK HISTORY <br /> as Tank test edTes o ailed precision test ? es o If yes, give date(s) <br /> Jas a repair made to the tank system? es No 11f yes, what was repaired? <br /> as repair done under inspection? es !Eere soil samples analyzed? es oTXE PH-G PH-D b/EDBype of failure/discharge atastrophic leakage verfill nknown ther: <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 � of/Year verage Annual Precipitation = 4 0 25 <br /> n-Site Wells} es oumber & Type Irr om ub <br /> S core S core S core <br /> istance to Well(s) from Tank ft; ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1-100 S 25-5011 <br /> Fractures in subsurface (applies to foothills or mountain areas) 1 Q None Unknown resent <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 KXXXXXX 26-40)2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxrx�xx None / one one <br /> COLUMN TOTALS>>>TOTAL POINTS V + l + S q-3 <br /> ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> L P�" X a I efl"\ <br /> B 1 T X E B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA <br /> 1 <br /> Sample Result- GASOLINE 1000 100 10 <br /> �Q� AXIMUM ALLOWABLE TPN LEVELS (PPM) <br /> TPH IESEL 10,000 1000 100 <br /> FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching 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 BTXBE 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 VIN01 <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 /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION YES 0 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME OF (- <br /> VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />