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SAN JOAQUIN CCU)' -}`USLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH" "pVISION <br /> UL SHEET FOR SITE CLOSURE EVALUATION DATE <br /> ,£ OF FACILITY ) /-�mr SWEEPS CODE <br /> OGRESS515 "-, - o, TANK ID S 'g� - <br /> .LANK SIZE 3� � FUEL T `L��-C-. <br /> meNERAL SITE HISTORY <br /> •may <br /> permit current] Yes No Penoii # - Facility Status Code f Doc.Soit/GW Cont les No <br /> , A'u-sber of Tanks at facilityAge of Tanks(if available) Lz Type of Tank Steel Fbrgl Sngl Dual <br /> TANK HISTORY (/l L <br /> Tank tested] Yes No 1XIFailed precision test 7 Yes No if yes, give date(s) <br /> .,.0 a repair made to the tank system] Yes No If yes, what was repaired? <br /> 'as repair don.: under inspection? Yes No Were soil samples analyzed] Yes No STXE TPH-G TPH-D Pb/EDB <br /> }pe of failure/discharge .catastrophic long-term Leakage overfill unknown other: <br /> . .REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Eos! Samples Received Yes No Depth to Ground Vater �,� Ref/Year $' � Average Anvwal Precipitation A= 14 10-25 <br /> -Site Wel!(s) Yes No Nurber S Type Irr Dan Pub <br /> . S Score S Score 5 Score i <br /> atlstance to WeLL(s) from Tank -Lj20—ft; c2.ix7 ft; ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> ... R condition R condition R condition <br /> J. Site Feature - Leaching Potential Analysis E is met E is met E is met 'I <br /> LMSnimum Depth to groundwater from the Soil Sample (feet) &0 — >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present <br /> :,Average Annual Precipitation (inches) Xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> '1xan-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water wells, ponds) None Unkrown s Present , <br /> `On ique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> } xxxxxx None - one one <br /> i <br /> COLUMN TOTALS>>>TOTAL POINTS <br /> io <br /> I_Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> SY,T N� pnM B T X E S T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. HA\3 <br /> iSanpte RGst(tj: 1 ry1 GASOLINE 1000 100 10 <br /> `(Gtt }: yam_ MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> f1,S}pH DIESEL 10,000 1000 100 <br /> FOOTNOTES: "•If documented soil and/or ground water contamination is present, do not couplets the leaching potential <br /> I, analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) <br /> \1 If depth is > 5 ft. and < 25 ft., score 0 points. if depth < 5 ft., do not use table. <br /> 'j \2 If precipitation is > 40 inches, score 0 points. <br /> IL_ \3 Levels for BTX8E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (di <br /> es <br /> el). } <br /> 'FE. STAFF RECOMMENDATION/CONCLUSION - �'>, VIA- GK <br /> 1. Are SIX b E or TPN Concentrations > Allowable Levels •Yes No �' /��� ��� G7 . <br /> 2. Recanmend Site Closure Yes No� 'If Yes, Refer to Site Mitigation for Evaluation <br /> ';fl. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> :DATE REFERRED / / DATE CLOSURE LETTER NAILED / / <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 �n �; �n `II' <br /> Al Cha l��y� G/1� J ✓ tf- <br /> i2�CP�e. <br />