Laserfiche WebLink
j n <br /> SAN JOAQUIN COUNTUILIC HEALTH SERVICES/ENVIRONMENTAL HEALTH <br /> UGS. RKSHEET FOR SITE CLOSURE EVALUATION DATE -`�1.1� <br /> '.:NAME OF FACILITY SWEEPS CODE <br /> ADDRESS �5[ 1 -J TANK ID $13? <br /> ITANK SIZE ,C, ' FUEL TYP <br /> Ii.. GENERAL SITE HISTORY U <br /> -�s permit currentt Yes No Permit U - Facility Status Code: s % Doc.soil/Gw Cont Yes No <br /> - Nunber of Tanks at facility Age of Tanks(if available) Type of Tank Steel Fbrgt Sngl Dual <br /> TANK HISTORY - LU-�'✓NU ' <br /> -,.as Tank [es:ed7 Yes NaIx I Failed precision test 7 Yes No If yes, give date(s) / / <br /> ,as a repair made to the tank system? Yes - No If yes, what was repaired? <br /> �Jas repair done under inspection? Yes Nol were soil saaples are lyzed? Yes No BTXE TPH-G TPH-D II <br /> Pb/E08 <br /> Type of failure/discharge catastrophic long-term leakage overfill unknown other: <br /> i; REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) - <br /> ;Soil Sanples Received Yes IN <br /> o Depth to Ground water Ref/year Gj ; Average rcondi <br /> cipitation A= 14 10-25 <br /> Or.-Site 'Jell<s) Yes No Nunbe"Type Irr Dam Pub <br /> S Score S S score <br /> Distance to WeLL(s) frac Tank ft;: 1 t- ft; a-OrC ft C 10 pts C C 5 pts <br /> 0 if 00 if <br /> '— — R condition Ron R condition <br /> t. Site Feature - Leaching Potential Analysis E is we E E is net <br /> minim Depth to groundwater frac the Soil Sampte (feet) G p— >100 01 51-100 25-50\1 <br /> ,.Fractures in subsurface (applies to foothills or mountain areas) I None Unknown Presenc <br /> Average AnnuaL Precipitation (inches) <br /> xxzzxx <10 9 10-25 xzxxzxx 26-40\2 <br /> 1Man-Made conduits which increase vertical migration Nane Unkamwn present <br /> rf Leachate (i.e., septic systems, water wells, ponds) <br /> lUnique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> one one <br /> X XXXX None <br /> COLUMN TOTALS»>TOTAL POINTS V e O `S <br /> Sample Result: (8 T ,Xg.OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts 40 pts or less <br /> -D CJ t r f r' B T X E 8 T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 <br /> i5anple GASOLINE 1000 100 10 <br /> Result: <br /> fPkF 3,l P M MAXIMUM ALLOWABLE TPH LEVELS (PPM) DIESEL 10,000 1000 100 <br /> TPN <br /> '*'If documented soil and/or ground water contamination is present, do not ccaplete the Leaching potential <br /> 'FOOTNOTES:,t analysis. (i.e., site is currently on UGT Cantaminetion List for soil or ground water.) <br /> I \1 if depth is > 5 ft. and a 25 ft., score 0 points. 1f depth <=5 ft., do nct use table. <br /> \2 if precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) oor 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPN Concentrations > Allowable Levels -Ye s No 04K� Or/ft'�Tr . <br /> 2. Recommend Site Closure Yes No <br /> If Yes, Refer to Site Mitigation for Evaluation (/CCd _ <br /> V11. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISCR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOAIRE YES NO REFEARED TO SITE MITIGATION FOR EVALUATION YES NO <br /> GATE REFERRED / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVAL'JATCR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />