Laserfiche WebLink
SAN JOAQUINTT PUBLIC HEALTH SERVICES/ENVIRONMENTAL H DIVISION <br /> I GST WORKSHEET FOR SITE CLOSURE EVALUATION ATE r <br /> ANE OF FACILITY Qti 7 - EEPS CODE `73� <br /> DRESS ANK ID # - <br /> PJCKa <br /> TANK SIZE i Cp p UEL TYPE c{ <br /> II GENERAL SITE HiSTORY ** <br /> is permit currentl es o ermit 9 - acitity Status Code oc.Soil/GLi Cont es o <br /> umber of Tanks at facility 3 ge of Tanks(if available) 3 f Irype of Tank teel I qbrgL I ngI Dual <br /> III TANK HISTORY <br /> Jos Tank tested? es o ailed precision test 7 es o If yes, give date(s) <br /> Jos a repair made to the tank system? es No f yes. what was repaired? <br /> as repair done under inspection? <br /> as a ere soil. samples analyxed7 es o TXE PH-G PH-D b/EDB <br /> ype of failure/discharge atastrophic long-term leakage verfill nown I lother: <br /> IV REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received es V a epth to Ground water ocs of/Year gj3 verage Arcual Precipitation a 4 0-25 <br /> -Site wells} es o umber & Type Irr om �ubfl <br /> 5 core S core 5 core <br /> istance to weLI(s) from Tank ft, ft; ft C 0 pts C pts C pts <br /> 0 if 0 if 0 f <br /> R rondition It ondition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Sail Sample (feet), , 3.100 1-100 25-50L 11" <br /> -0-- <br /> Fractures in subsurface (applies to foothilts or mountain areas) None Unknown Present <br /> %verage Annual Precipitation (inches) KXXXXX <10 9 10-25 xxxxxx 1 26-40\2 <br /> an-Made conduits which increase vertical migration / Unknown resent <br /> f leachate (i e., septic systems, water wells, ponds) None <br /> ique site features: Recharge area, coarse soil, nearby wells C7 At least 4ore than <br /> xxxx None one One <br /> COLUMN TOTALS»>TOTAL POINTS �c/ + 7 + <br /> aa�myyple Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> /��1 /3�'^�2� �`'� B T X E B T X E <br /> r����?"{ MAXIMEMYI ALLOWABLE B-T-X-E LEVE <br /> L5 (PPM) 1 50 50 50 .3 .3 1. 1. NA�3 <br /> ample Resutt-F b: ktieJJ SOLINE 1000 100 10 <br /> Pc ' n�cCias rl�� iMUM ALLOWABLE TPH LEVELS (PPM) 1000 <br /> 5/00 TPH IESEL 10,000 100 <br /> FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potential <br /> 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 /> _\2, if precipitation is > 40 inches. score 0 points. <br /> L Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel) <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX & E or TPH Concentrations > Allowable Levels Yes I V�o <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> V11. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> i [VALUATOR <br /> WITH STAFF RECOMMENDATION FOR CLOSURE E5 0 EFERRED TO SITE MITIGATION FOR EVALUATION E5 O <br /> EFERRED / / ATE CLOSURE LETTER MAILED <br /> OF <br /> EH 23 80 (UGTWKSHT)\5/90 <br />