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SAN JCAaJIN CCY.'NT�Tj�., �IC HEALTH SERVICES/ENVIRCHMENTAL HEALTH 0ON <br /> UGS _ SHEET FOR SITE CLOSURE EVALUATION ` �J AtE <br /> F <br /> FACILITY I V l a e— W�7' V1EEPS CODE - D q v <br /> OREssI6PLO Lf l�fln MANX t0 s �3 <br /> LINK SIZE O UEL TYPELv -�f . <br />. <br /> GENERAL SITE HISTORY - <br /> Its permit Curren[? es o ermiC - O q8 acitity Status Code 0 oc.So'l/C.n Conc es o <br /> Number of Tanks at facility age of Tanks(if available) l l / ype of Tank teel lylFbcqt ngl Ovat . <br /> 1. TANK HISTORY <br />'as Tank tested? es o ailed precision tes es o If yes, give dates) <br /> Was a repair made to the tank system? es No f yes, what was repaired? <br />:as repair done under inspeation7 es ere soil samples analyzed) es o TXE PH-G I PX-O b/EOB <br /> type of failure/discharge a[astroytic long-term leakage vert ill n cher: <br />. REMOVAL HISTORY CATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Sail Samples Received 11 <br /> Aeso epth to Gratedlater of/Tear vrage Arnual Precipitation = 4 0.25 <br />)n-Site Wells) es tuber S Type Irr anS core 5 core 5 care <br />)istanee to Well(s) frft; ft; • it C 10 pts C 9 PCs C pts <br /> 0 if 0 if 0 f <br /> R ondition R comitim R ordition <br />/. Site Feature - Leaching Potential "lysis E is met E is met E s met <br /> liniTAm Depth to groundwater from the Soil Sample (feet) ;100 t-100 25-50\1 <br /> rractures in subsurface (applies to foothills or matncain areas) Mme Unknown resent n <br /> lvcrage Armal Precipitation Cinches) Xxxx 410 9 10-25 x==tx 26-40\2 <br /> tan-Made Conduits which increase vertical migration <br />)f leachate Ci.e., septic systems, water wells, pords) None Unknown resent <br /> Hague site features: Recharge area, coarse soil, nearby wells. At least ) 4oce than <br /> More one one <br /> COLUMN TOTALS»;TOTAL POINTS • <br />;ample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 PCs 40 pts or less <br /> BT X E B T X E <br /> MAXIALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br />;ample Result: OLtNE loco 100 10 <br /> �AXIKM ALLOwABCE TPX LEVELS (PPM) <br /> TPN IESEL 10,000 1000 100 <br />'COTHOTES: •"If dxemenced soil and/or grand water contanination is present, do not complete the leaching potential <br /> arnlysis. (i.e., site is currently on UGT Contamirutim List for soft or ground water.) i <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 IC., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for 3TX3E are not applicable at a tPH concentration of 10 ppm Cgasol ine) or 100 ppm (diesel). <br /> STAFF RECCMENDATION/CCNCLUSION <br /> 1. Are BTX S. E or TPH Concentrations > AttolAt Levels Yes 01 1 <br /> 2. Recommend Site Closure es o if Yes, Refer to Site Mitigatim for Eva I Us C-1 <br />. REVIEW EVALUATION - To BE COMPLETED BY A SL'PERVISCR/SEMICR <br /> OHCJR WITH STAFF RECOMMENDATION FOR CLOSURE 4E5 0 EFERRED To SITE HITICATICH FOR EVALUATION IIYES 0 I{I <br /> MIS REFERRED / / aiE ttOSURE LETTER )4LI LE0 <br />—IME OF Ii1 <br />:vnwniOR <br /> EH 23 00 (UGTw'KSHT)\5/g0 - <br /> i <br />