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SAN JOAQUIN COUNTY PUP, '^ HEALTH SERVICES/ENVIRONMENTAL HEALTH D1YI <br /> UG' J ET FOR SITE CLOSURE EVALUATION DATE f <br /> rr WEEPS CODE <br /> ?[AME OF FACILITY hp� �_"C,— 4 <br /> 5JS 11 01 -- <br /> ADDRESS D U r H <br /> TANKSIZE O FUEL TYPE0 j! h P [,c/Jrvu^ <br /> GENERAL SITHISTORY I T'1"l� �� �O�` r V V f A <br /> :** <br /> Is permit current? Yes No Permit # - Facility Status Code DOC.SoiI/GW Cont Yes No <br /> Number of Tanks at facility Age of Tanks(if available) Type of Tank Steel Fbrgl Sngl Dual <br /> I. TANK HISTORY <br /> was Tank tested? Yes No Failed precision test 7 Yes No If yes, give date(s) <br /> wasa repair made to the tank system? Yes No If yes, what was repaired? <br /> Was repair done under inspection? Yes No Were soil samples analyzed? Yes Ho BTXE TPH-G TPH-0 Pb/E08 <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> Y. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received Yes No Depth to Ground water UO Ref/Year [l;p Average Annual Precipitation A= 14 10-25 . <br /> On-Site Wells) Yes No Number & Type Irr Dom F`ub S Score S Score 5 Score <br /> Distance to Wells) from Tank ft; ft; ft C 10 pts C 9 pts C 15 pts <br /> O If 0 if 0 if <br /> �\ condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis \ is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet) 100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) Non\ Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-Made conduits which increase vertical migration <br /> of leachate (i.e., septic system, water wells, ponds) None U wm Present <br /> ms <br /> Unique site features: Recharge area, coarse soil, nearby wells. t le More than <br /> xxxxxx None on one <br /> COLUMN TOTALS»>TOTAL POINTS ; ~ <br /> Sample Result: (8 T X OR E) pp RANGE Of TOTAL POINTS 49 pts or more 41 - 48 pts \40 pts or less <br /> f 3 ''"'"` is V B T X E B T X E <br /> 2'f � <br /> T. <br /> �{ MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. <br /> Sample ResultLa6k %I7- GASOLINE 1000 100 10 <br /> MAXIMUM ALLOWABLE TPN LEVELS (PPM) <br /> TPH �A� <br /> DIESEL 10,000 1000 100 <br /> G <br /> FOOTNOTES: ***If'documented soil and/or ground water contami a leaching potential <br /> analysis. (i.e., site is currently G tamination List for soil or gro er.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 1 de th <=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, scare 0 poin _ <br /> \3 Levels for BTX&E are not applicable at a TPH conte ne) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPH Concentrations > Allowable levels *Yes No <br /> 2. Recomsiend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation <br /> V11: REVIEW EVALUATION - TO BE COMPLETED 8Y A SUPERVISOR/SENIOR <br /> 4 <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE TES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED / L{ / �l DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br /> f <br />