COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I. FACILITYITANK INFORMATION DATE: SITE/FACILITY NAME: I r6 STATUS CODE: ADDRESS: 148 ,a? L2( CITY: FA# 2 1 IS(, I PR# CJ �6 C1OU TANK# TANK SIZE: N/A FUEL TYPE: 11.,,GENERAL SITE HISTORY Is Permit Cu en . x Yes L3 No Documented Soil/GW Contamination?*** ❑ Yes LJ No Number of Tanks at Facility Age of Tanks(if available) Type of Tank❑Steel ❑Fiberglass ❑Single ❑Dual III. TANK HISTORY Was Tank Tes.ed? ❑ Yes ❑ No Failed Testing? ❑ Yes ❑ No Yes, Provide Dates: Was Tank System aired? LJYes L) No If Yes,Describe Repair: Was Repair Done Under mit? LlYes L3 No Were Soil Samples Analyzed? ❑Yes E3 No L3 BTEX LJTPH-G E3TPH-D LJ LEAD LJ Ll OTHER Type of Failure/Discharge: ❑ Ca trophic ❑ Long-term Leak ❑ Overfill ❑ Unknown ❑ Other IV. REMOVAL HISTORY(Attach File Soil Samples Re 'ved? x Yes ❑ No Seasonal High Depth to GW ft bgs Year/Reference Onsite and/or Nearby )? ❑Yes L3No LJ Irrigation: # istance to Tank ft � Score 10 C Score 9 C ❑ Domestic:# Dis a to Tank ft 0 points if 0 points if O Score 5 points if LJPublic: # Distance Tank ft R condition is R condition is R condition is met V. SITE FEATURE—LEACHING POTENTIAL ANALYSIS E met E met E Minimum Depth to Groundwater from Soil Sample Depth(feet)*yS >100 51 -100 25-501 Fractures in Subsurface(applies to foothill or mountain areas) /0 None Average Annual Precipitation(14 inches for SJC area) -------- <10 9 10-25 -------- 26-402 Man-Made Conduits which Increase Vertical Migration ---- C! i.e.septics stems,water wells,ponds) — None ' Unknown Present Unique Site Features: Recharge Area,Coarse Soil(coarse sands, None At Least One More Than One gravels), nearby wells Column Totals Total Points + + _ Sample Results for BTEX: Range of Total Points 49 Points or More 41 —48 Points 40 Points or Less Maximum Allowable BTEX B TE X B T E X N/A3 Levels m 1.0 50F50 50 0.3 0.3 1.0 1.0 Sample Results for TPH: Maximum Gasoline 1,000 ,,l 100 10 Allowable TPH Levels(ppm) Diesel 10,000 1,000 _�f 9,Z� 100 Footnotes: ***If documented soil and/or groundwater contamination is present,do not complete leaching potential analysis(i.e.site is already on the contamination list). t If depth is>5 feet and<25 feet,score 0 points. If depth is-5 feet,do not use table. 2 If precipitation is>40 inches,score 0 points. 3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. VI. STAFF RECOMMENDATION/REFERRAL/REVIEW 1. Are BTEX or TPH Concentrations>Allowable Levels. Yes ❑ No 2. If No, Is Site Closure Recommended? ❑Yes ❑ No Completed By: Gtg k Irl Date Referred to Site Mitigation Unit for Final Actiont Reviewed By: Concur with Staff Recommendation ❑Yes ❑ No Date Closure Letter Mailed tAll Cases are Referred to Site Mitigation for Final Action *Subtract soil sample depth from groundwater depth to determine distance be sample depth and groundwater EH 23-0080(Rev6/4/2007)