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SAN JOACUIN ITY PUBLIC LTH S'c3VICES/ENVIRCNME4TAL HE' DIVISION <br /> ///•��� _GSi WORKSHEET FOR SITE CLOSURE EVALUATICN DATE ( 7 - <br /> Ii Of FACILITYjr�y,�A� TMVIte L�h . � _ ISYE'?S CODE ( <br /> RESSIV CG S�69L4 J/,�/71JYCJ ( TANK ID <br /> 317EI /,) 00 1FUEL TYPE <br />--:NERAL SITE HISTORY <br /> I•ermit current? Yes No ( Permit dl ( Facility Status Cade l D I IDee .S it/GW Ccnt Yes No <br /> zr of Tanks at facility ) ( Age of ianks((iif available) LI Type of Tank l Steel FbrgL SngII OuaLI <br /> ANK HISTORY YT <br /> Tank tested? Yes INoI Faited precision test ? IYesi INoI lIf yes , give dare( s ) / / / / l <br /> a repair made to the tank system? IYesl Nal IIf yes , what was reps rea? 1 <br /> repair done under inspection? iYes l lNoi ( Were soiL samples analyze? i Yesl INoI BTXEI 1TPH-G ' 1TPH-DI iPb/EDB ( <br /> I: of `ailure/discharges catastrcphicl ( long- term leakage ) loverfiIL ) unknown) ) other: 1 <br /> IiMOVAL HISTORY (ATTACH INSPECTION .REPORT FOR SITE DETAILS/COLE_--CT DATA FOR LEAC3ING POTENTIAL ANALYSIS) <br /> Samoles deceived I Yes INo I Depth to Ground 'Jater � lRef/Yearl (�✓1j ) Average ArruaI Precipitation ) A= I 14 110- 25 � <br /> lite Well ( s ) YesINoI INumcer 3 Type ltrrl Daml Punl <br /> S Score S Score S Scare <br /> ance to WeLL ( s ) from Tank ) ft ; -- ft C 10 pts r9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> Site Feature Leaching PotentiaL Analysis 3 _ I Sy.�D _ is met _ is met I E is met <br /> mum Depth to groundwater from Lle SaiL Sample ( feet ) 1 > Ica I 151 - 1110 <br />,tures in subsurface ( applies to foothills or mountain areas ) I 1 V 1 Nene 1 Unknown 1 CJ Present - <br />'age Annual Precipitation ( inches ) Ixxxkxxl <1C 1 9 10 - 25 xxxxxxxl Z5-40\2 <br /> Made conduits 'which increase verticaL migration <br /> eachate ( i . e . , septic systems , water weLLs , Pans ) / G Hone Unknown ( Present <br /> us site features : Recnarge area , coarse sail , nearby wells _ I At Least More Chan <br /> pccxx <br /> xNone R ane I //one <br /> COLUMN TOTALS>>>TOTAL POINTS <br /> Is Result : ( 3 7 X OR e) RANGE OF TOTAL POINTS 49 Pis or more l 61 - :a pts 1s or 1 <br /> E - x = . 5so <br />�1 U) 3 7 X i 3 T X E <br /> NAXIMUN ALLOWABLE 3-i-X-E LEVELS (PPM) 1 50 i0l 50 I .3 .3 1 _ 1 NA\3 <br /> Is Result : Tg I1< GASOLINE 1000 1 100 10 <br /> y MAXIMUM ALLOWABLE TPN L_eVEL S (PPM) <br /> ja OOTPH D DIESEL 10 , 000 l 1000 l 100 - <br /> VOTES : " if documented sail and/or ground eater contamination is present , do not calplete the _ acning potential <br /> analysis_ ( i . e„ site is currently on UGT Contamination List for sail or graaid w , <br /> \1 If depth is > 5 ft, and < 25 ft . , scare 0 points- If depth c-5 ft . , do not use table. l <br /> \2 If precipitation is > 40 inches , scare 0 Points_ <br /> \3 Levels for 3TXSE are nal applicable at a TPH concentration of 10 ppm (gasoline) or 100 Ppm (diesel) _ <br /> lFF .RECCMMENDATICH/MNCLUSICNyam . ^ ; n " I y <br /> Are 3TX 3 E or TPH Concentrations > Allowable Levels *Y es XNOl l ✓/_{-� 17 / ' 1J <br /> Recommend Site Ctosure lYesl No If Yes , Refer to Site Mitigation for Evaluation ) <br /> R C <br />?IIEW n/ALUATION - TO 3E CCMPLETZO BY A SUPERVISCR/SEAICR <br /> AMR WITH STAFF RECCMME30ATICN FOR CLOSUREIYEsI INOI ( REFERRED TO SITE MITIGATION FOR EVALUATIONIYESI MAOI <br /> REFERREDl / / ( DATE CLOSURE L_-7TER HAILED ( <br /> OF <br /> UATORI <br /> 3 30 (UGTIIKSHT ) \5/90 <br /> d <br />