Laserfiche WebLink
RDNMENTAL <br /> SAN JOAQUIw`CVTY MIC HETH <br /> EVALUATION <br /> DIVISION ATE p 0 <br /> I• UGST WORKSHEET LTH SITE CLOSURE <br /> OF FACILITY a p EPS CODE <br /> ss 23,3'"o or• <br /> ANK los � • ;zy 2` <br /> PS12E L TYPE <br /> 11. GENERAL SITE HISTORY ** <br /> s permit current? as o V t 0 - scility Status Code oc.Soil/GY ContMyo <br /> kqe r of Tanks at facility <br /> of Tanks(if available) �r,,K ype of Tank tool brgl t Dust <br /> III. TANK HISTORY <br /> in Tank tested? es o r ailed precision test ? es o '� 1f yes, give date s) <br /> s a repair made to the tank system? as No 7 f yes, what was repaired? <br /> s repair done under inspection? es o re soil samples anatyzed? es o TXE=E7779 <br /> ype of failure/discharge atastrophic ong-term leakage fill thar: <br /> IV. REMOVAL HISTORY (ATTACH INSK TION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> . � (, vera" Annual Precipitationrti <br /> it Samples Received es o th to Ground Mater O of/Year c ,-Site Wltts) es o r 3 Typetrr omS core S core S istance to Netl(s) from Tank ft; ft; ft C 0 pts C pts C 0 'f 0 if 0 R audition R audition R Site Feature - Leaching Potential AnalysisE s met E is met _ E <br /> r1nfimum Depth to groundwater from the Soil Saapte (feet) 100 1-100tures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> age Annual Precipitation (inches) xxxx <10 9 10-25 26-40 7 <br /> 4M-K&&- <br /> conduits which increase vertical migration , None Unknown resent <br /> f leachate (i.e., septic systems, water wells, ponds <br /> At least e than <br /> ique site features: Recharge are , coarse soil, nearby wells. xxxx None ane one <br /> COLUMN TOTALS> >TOTAL POINTS i O <br /> e Result: (B T % OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> SamplBIT Ix 1E B T X E <br /> MAXI" ALLOWABLE B-T-X-E LEVELS (PPM) 1150150150 .3 3 NAS <br /> to Result: INE 1000 100 10 <br /> TPN—D M <br /> IK ALLOWABLE TPH LEVELS (PPM) [ESEL 10,000 1000 100 <br /> OOTNOTES: if documented snit and/or ground water contamination is present, do not complete the leeching potential <br /> analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br /> .\1 If depth is > S ft. and < 25 ft., score 0 points. If depth <=S ft., do not use table. <br /> _ If precipitation is > 40 inches, scare 0 points. <br /> \1 levels for BTXLE are not applicable at a TPN concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOi1KENDATION/CONCLUSION <br /> 1. Are BTX i E or TPH Concentrations > Allowable Levels Yes o <br /> 2, Recosmeerd Site Closure es if Yes. Refer to site Mitigation for Evaluation <br /> Vll. REVIEY EVALUATION - TO BE CO)1PLETED BY A SUPERVISOR/SENIOR <br /> ES EFERRED TO SITE KITIGATION FOR EVALUATION rEST <br /> VITH STAFF RECOmmENEDAT:1:011 FOR CLOSMME <br /> ATE REFERRED ATE CLOSURE LETTER MAILED <br /> OF <br /> VALUATOR <br /> EN 23 8O (UGTYKSNT)\5/90 <br />