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SAN JOAGUIN CCU- AC HEALTH SERVtC_S/ENVtRONMENTAL HEALrf 1 <br /> UGSr t�SxEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF fAC:LITY I p1e EEPS CODE <br /> 70RESSS D C G /'L a &6' AHK f0 <br /> 3NX SIZE 10vQ0 UEL TYPE 00 ( `e <br /> GENERAL SITE HISTORY <br /> permit current7 es o ermit 9 aeitity Status Code oe.So WCW Centes o <br /> 1 <br /> tuber of Tanks at facility l ge of Tanks(if avaitable) ype of rank teel brgl ngl OuaI <br /> TANK HISTORY <br /> s tank tested? es o ailed precision test ? es o If yes, give date(s) <br /> a repair made to the tank system? IYes Ho1 11 f yes, what was repaired? <br /> repair done under inspection? l4es I Ref ere soil samples analyzed? es o TXE I PH-G I �PH-0 I b/EDB <br /> -le of failure/discharge atastrophic long-term tea kage verfilt cher: <br /> EMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> t Samples Received I es o epth to Graced later � of/Year F-6 ; G verage Arnual Precipitation s 4 0-25 <br /> Site lett(s) es Jvlo <br /> umber b Type irr pan <br /> S care S core S core <br /> tante to /ell(s) from Tank 1p�_ft; ft; ft C 0 pts C pts C pts <br /> 0 f 0 if 0 f <br /> R ondition R ondition R ondition <br /> Site Feature - Leaching Potential Analysis 410— 15 -� a5 E 's met E is met E s met <br /> imam Oeoch to groundwater from the Soil Sanpte (feet) I >100 I i-100 25-50\1 <br /> tures in subsurface (applies to foochitls or mountain areas) None Unknown present <br /> age Arrwat Precipitation (inches) ax= <10 9 10-25 26-40\2 <br /> Made conduits which increase vertical migration <br /> enchace (i.e., septic systems, water we ts, ponds) None I Unknown �resenc <br /> e site features: Recharge area, coarse soil, nearby wells. n I zxx None At leas t 4cre than <br /> 7 one one <br /> COLUMN TOTALS»>TOTAL POINTS lo * i ,y / D <br /> to Result: (8 T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 48 pts 40 pts or less <br /> B T X EB T X E <br /> MAXIM7i ALL04IA8CE 8-T•X-E LEVELS (PPM) 1 50 50 50 � .3 .3 1. 1. NA\3 <br /> j e Ret �Zt-3 <br /> CLINE1000 100 10 <br /> UM ALLOUABLE TPH LEVELS (PPM) <br /> 7lESEL 10,000 1000 100 <br /> OTES: *"If documented soil and/or ground water contamination is present, do not complete the teaching <br /> analysis. (i.e.. site is currencty on UGT Contamination List for soil or . potential, <br /> wa <br /> \I If depth is > 5 ft. and < Z5 ft. score 0 ter.) <br /> points. If depth <.5 ft., do not use cable. <br /> \2 If precipitation is > 40 ine5es, score 0 points. <br /> \3 Levets for BTXSE are not appticabte at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> FF RECCHMENOATION/CCNCLUSION ej<, ,3 <br /> *1-i 1t <br /> Are 3TX S E or TPH Concentrations > Allowable Leve{s Yeso /71 .gyp-��� TZ+$C3'�fi <br /> eeommend Site Closure es o <br /> If Yes, Refer to Site Mitigation farcvaluatien <br /> /IEW EVALUATION - TO BE CCMPLETED BY A SUPERVISOR/SENIOR <br /> R VITH STAFF RECCHME40ATION FOR CLOSURE ES I EFERREO TO SITE HITIGATICH FOR EVALUATION ES 0 <br /> REFERRED / / ATE CLOSURE LETTER :1AILED f <br /> OF <br /> a TCR <br /> 90 (UGTt1KSHT)\5/90 <br /> i <br /> f <br />