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SAN JOAQUIN ._JNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE 3 OIV [SI. DATE ! <br /> I - <br /> UGST WORKSHEET :OR SITE CLOSURE EVALUATICN j. <br /> 11 11 !' 1Swi CODE ( 1 3 v <br /> ( NAME OF FAC( LI Y I oil <br /> J <br /> _ U r S�• hA TANK IO '. 3 7 - <br /> (;( ADDRESS ( 1 ti C GC. I <br /> ( TANK SIZGI I L/ � ( FUEL TYPEMULL <br /> Ir . GENERAL SITE HISTORY r C <br /> Is permit current? ( Yes Hal ( Permit1Faci IIty Status CadelQ / IOac.Soi UGW Cantl7es <br /> j mu er of Tanks at facility <br /> ( Age of Tanks( if available ) ( l�j ITYPe of Tank ! Steel Fbrgll 15ngll Ouall <br /> ) VN <br /> (III . TANK HISTORY j <br /> Was Tank cested? IYes Na IFailed precision test ? IYes I No iIf Yom • give date( s ) I <br /> Was a repair made to the tank system? 1Yes1 Not [ f yes , what was repai red'� I <br /> lill III BTXE ITPH-G TPX-DI Pb/E08 <br /> Was repair done under inspectioni Yesl INo1 Were sail samples analyzeal Yes INaI II <br /> Type of failure/discharge ! lcatastrophtcl ) long- farm Leakage ) lovem LLI Iunknawnl lather <br /> 11V . 2EMOVAL 'HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA POR LEACHING POTENTIAL ANALYSIS) <br /> ( Sail Samples .Received ) Yesl INoI ( Depth to Ground Waterl ( Ref /Year ) <br /> 1Average Arcual Precipitation` A= I 14 10- 25 <br /> 1 <br /> 1I Il <br /> On- Sice WeIL ( s ) IYes t INoI � Nuce1rrDomIPubjo <br /> r 3 Type S Score Scare 3 Score <br /> f. ; qi� C 10 pts 9 Pts C 5 ots <br /> ( Distance to Well ( s ) from Tank ) ft; Q if 0 tt <br /> 0 if <br /> Rcanaft ion R condition R condition <br /> is met E is met E is met <br /> � V . Site Feature - Leaching Patential Analysis 1 <br /> feet ) o >100 I 151 - IDD 25 -iC\ i 1 <br /> IMinimun Depth to groundwater from the Soit 'aainate ( � 5 ' �j �b 1 <br /> ! Frac ores in subsurface ( applies o faothiL is or mauntai ❑ areas ) <br /> I v I Nare I I Unknown I ( Present <br /> Ixxxxxx� 10 I 9 i 10 Z5 lxcxxxxxl 25 40\Z <br /> Average Annual Precipitation ( inches ) i <br /> Man-Made conduits <br /> which ich increase vertical migration I D I None I Unknown 1 ! present <br /> of leachate ( i . z . , septic systema , water we! Ls , ponds ) 1 <br /> l Chan <br /> ^ f At Leestl ( Mare <br /> ) Unique site features : Recharge area , coarse sail , nearby wet Ls,, Xxaxxl Norte /'--7(� I � one <br /> 11 <br /> gaol - 1 " <br /> COLUMN9 <br /> i0TALr>TDTAI POINTS l 1 <br /> SamResult :ale (ELr X OR =) RANGE OF TOTAL POINTS 49 pis or mar—_ I 41 - 43 pts 40 lots or less <br /> � KI x = ag0 31rIX � El3iTIX1 <br /> MAXIMUM ALLOWABLE 3-i-X-E IJ-VELS (PPM) 1 00 00 50 .3 3 1 . <br /> lill Will millill ION ION GASOLINE 1000 ( 100 <br /> mpi 10 <br /> Sale Result : <br /> 1 K I �, L INUM ALLOWABLE TPH LEVELS CPPM) DIESEL 10 , 000 1000 100 <br /> TPI D <br /> FOOTNOTES : <br /> �If docuiented sail and/or ground water cantaminetian is presort , do not conplete the teaching po zntiat <br /> anatysis . ( i .e. , site is currently on UGT Contamination List for sail or ground wafer . <br /> \1 If depth is > 5 ft- and < 25 ft . , scare 0 paints. If depth <=5 ft . , do not use table- <br /> \2 if precipitation is > 40 inches , scare 0 points_ <br /> \3 Levels for 3TXZE are not applicable at a TPN tancentration of 10 peen Cgasoline) or 100 ppm <br /> VI . STAFF RECOMMENDATION/CONCLUSION <br /> 1 . Are 3TX 3 E or TPH Concentrations > At Lowab! e Levels IeYes Not <br /> 7P14 D � ,3660 %J <br /> 2, Recamnend Site Clasure Yes 1No F•If Yes , Refer co Site Mitigation for Evaluetian <br /> 3 -F � <br /> VII . REVIEW ?1ALUATION - IO 3E CDMP1.='TcD 3Y A SUPERVISOR/SENIOR <br /> P ?PHb =dd6ory' <br /> CCNCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES ! ING ! IREFERRED TD SITE MITIGATION FOR EVALUATIONYlINOI <br /> DATE REF=RREDI / / ( DATE CLOSURE LETTER MAILIDI <br /> NAME OF <br /> EVALUATORho4iie 13e <br /> kE - . <br /> EH 23 80 (UGTWKSHT ) \5 /90 & ill Y- <br />