Laserfiche WebLink
SAN 10ACUIN COUNTY .IC HEALTH SERVICES/EHVIRCNMENTAL HEALTH 0- ICN <br /> UGST w.e_KSHEET FOR SITE CLOSURE EVALUATION ArE <br /> AME OF FACILITY 9erma cl- He%en 5 mQ �n EPS CCOE <br /> noa£ss 3 JC �, C--� k h711-e � ANK ID x <br /> rANX SIZE I /Q K UEL TYPE <br /> i. GENERAL SITE HISTORY <br /> irIs permit current? des oermit x aeility status Code (J oc.S 'l/Gw Cone es o <br /> auni:er of Tanks at facility 5 ge of Tanks(if available) 'L Z r ype of Tank tee) best ngl Ouat <br /> (. TANK HISTORY Ian 40- M( <br /> ?as Tank tested7 es o ailed precision tes T es o If yes, give date(s) <br /> -as a repair made to the tark system? es No IV f yes, what was ,,air-d7 <br /> ras repair done under fnspection7 yes ere soil samples analyzedT es TXEPN-G PH-0 b/EO3 <br /> -ype of failureldischarge otos trophic It mg-term leakage vert ill1. noun Cher: <br /> leMOVAL HISTORY (ATTACH INSPE5MM REPORT FOR SITE DETAILS/COLLECT OATH FOR L'ACHINO POTENTIAL ANALYSIS) <br /> L Samples Received I as 0 epth to Ground 'daM <br /> verage Annual. Precipitation 4 0-25 <br /> ,-Site tfeMs) as umber 3 Type rrScaresaresCance to Vell(s) Fran Tank �/1ft; tr, C p[s Cptsif 'fim R cndition R sedition <br /> Site Feature - Leachins Patenttal Analysis E is met E- "s met <br /> iaxm Oepth to grourdwater from the Soil Sample (feet) IO- II' t7 1 'lea 1 1-100 1'7 25.50\1 <br /> ctures in subsurface (applies to foothills or maintain areas) Nme I Unknown resent <br /> :rage Amual Precipitation (inches) xxzx cl0 I 9 10-25 xxxxzx 26-40\2 <br /> -.Made conduits which increase vertical migration <br /> teschate (i.e., septic systems, water wells, ponds) None I I Unknown resent <br /> -.:e site features: Recharge area, coarse soil, nearby wells. At least ) or, than <br /> =xNone one I one <br /> l <br /> I <br /> CCLlR1N TOTALS»>TOTAL POINTS <br /> (e Result:a^.- IS T X CR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> E=$2 QQ>t <br /> 350" X-3S6HH MAXIMLM ALLCWAELE 3-T-X-E LEVELS (PPM) 11 SO I50 Iso .3 .3 1. 1. I NA\3 <br /> -. .e Result: I SOLINE 1000 100 I 10 <br /> 3cowy\ ftAXI1t1M ALLOWABLE TPN LEVELS (PPM) <br /> TPN I IESEL 10,000 1000 100 <br /> `OTES: •"If docu nted 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 sail or grovel water.) <br /> \1 If depth is > 5 ft. and c 25 ft., scare 0 points. If depth c=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levets for 3TXSE are not applicable at a TPH concentration of 10 ppm (gaso(ine) or 100 ppm (diesel). <br /> .FF RECCMMEHOATION/CCNCLUS(ON Leo-A p ' <br /> Are 3TX S. E or TPH Concentrations > All able Levels Yes o <br /> tecommerd Site Ctosure esFVF <br /> o If Yes, Refer to Site Mitigation for Evaluatim <br /> =.v IE'd EVALUATION - TO SE CC14PLETED OT A SL'PSRVISCR/SENICR <br /> ":R VITH STAFF RECCMMENDATtON FOR CLOSURE �ES 0 EFERREO TO SITE ,MITICAT(CH FOR EVALUATfCH AYES I 0 <br /> REFERRED ! / ATE CLOSURE LETTER MAILED d / <br /> OF X� L <br /> :ATOR <br /> Ra tunrurcwnicicn �. v <br />