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SAN JOAQUIN <br />NAME OF FACILITY I [,Ott 1* NV"yi <br />ADDRESS r:� S. Tvbi y vYL_ <br />TANK S I2E 16, to i7 (2 FUEL TYPE <br />I. GENERAL SITE HISTORY <br />PUBLIC HEALTH SERVICES/ENVIRONMENTAL <br />WCRKSHEET FOR SITE CLOSURE EVALUATION <br />i C/tN2Ko <br />DIVISION <br />DATE 5 -15_03 <br />SWEEPS CODE <br />TANK ID it AI -01 3.31 f) <br />Is permit current? Yes No Permit N - Facility Status Code Doc.Soit/GW Cont Yes N <br />Number of Tanks at facitity ' Age of Tanks(if available) Type of Tank Steel Fbrgt Sngt Dual <br />•rl TAUV UICTnOV <br />Was Tanktested? <br />Yes <br />No <br />No <br />Depth to Ground Water <br />Failed precision test T <br />Yes <br />No Y' If yes, give date(s) <br />Average Annual Precipitation <br />lWas a repair made to the tank system? <br />Yes <br />o <br />MOL <br />If yes, what was repaired? <br />r YDG�t vt""Y r' pifl►'e'& <br />Was repair done under inspection? <br />Yes <br />Dom <br />No <br />S <br />C <br />0 <br />R <br />E <br />Were soil samples analyzed? <br />Yes / No <br />BTXE <br />S <br />C <br />0 <br />R <br />E <br />TPH-G <br />Distance to Welt(s) from Tank <br />TPH-D - <br />Pb/EDB <br />Type of failure/discharge <br />Minimum Depth to groundwater from the Soil Sampte (feet) <br />catastrophic <br />),100 <br />long-term leakage <br />overfill <br />unknown other: <br />!V. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DAIA rwc LCA6n1nu rvic41+AL <br />(Soil Samples Received Yes <br />No <br />Depth to Ground Water <br />�"i <br />Ref/Year <br />rC ; CA <br />Average Annual Precipitation <br />A-114 <br />10-25 <br />On -Site Wells) Yes <br />No <br />Number Type <br />Irr <br />Dom <br />Pub <br />S <br />C <br />0 <br />R <br />E <br />Score <br />10 pts <br />if <br />condition <br />is met <br />S Score <br />C 9 <br />0 if <br />R condition <br />E is <br />pts <br />met <br />S <br />C <br />0 <br />R <br />E <br />Score <br />5 pts <br />if <br />condition <br />is met <br />Distance to Welt(s) from Tank <br />ft; ft; ft <br />V. Site Feature - Leaching Potential Analysis <br />Minimum Depth to groundwater from the Soil Sampte (feet) <br />),100 <br />/ <br />51-100 <br />25-50\1 <br />Fractures in subsurface (applies to foothills or mountain areas) <br />None <br />ClUnknown <br />Present <br />Average Annual Precipitation (inches) <br />xxxxxx <br /><10 <br />9 <br />10-25 <br />xxxxxxx <br />26-40%2 <br />Man -Made conduits which increase vertical migration <br />of leachate (i.e., septic systems, water wells, ponds) <br />None <br />Unknown <br />Present <br />Unique site features: Recharge area, coarse soil, nearby wells. <br />xxxxxx <br />None <br />At least <br />one <br />More than <br />one <br />COLUMN TOTALS»),TOTAL POINTS <br />; <br />; <br />Sample Result: (B T X OR E) <br />—r pD'► 5 <br />X t7.fb 5 <br />RANGE OF TOTAL POINTS <br />49 pts or more <br />41 - 48 pts <br />40 pts or less <br />MAXIMUM ALLOWABLE B -T -X -E LEVELS (PPM) <br />B'T <br />1 50 <br />X <br />50 <br />E <br />50 <br />8 <br />.3 <br />JT <br />.3 <br />X <br />1. <br />E <br />1. <br />NA%3 <br />Sample Result: <br />�j . `1-• b TPH <br />MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br />GASOLINE <br />1000 <br />100 <br />10 <br />DIESEL <br />10,000 <br />1000 <br />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, ppm (diesel). <br />vi Levwls for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 <br />VI. STAFF RECOlMIENDATIOM/CONCLUSION <br />Li - <br />Are BTX b E or TPH Concentrations > Allowable Levels 'Yes 1" No <br />2. Recommend Site Closure IYes No If Yes, Refer to Site Mitigation for Evaluation <br />VI _ _ _ ,. ee "woo cTen or L CIIDERVISOR/SENICR <br />CONCJR WITH STAFF RECOMMENDATION FOR CLOSURE YES 0 REFERRED TO SITE MITIGAIION FOR EVALUATION TES Na <br />DATE REFERRED / / DATE CLOSURE LETTER MAILED <br />NAME OF <br />EVALUATCR <br />cu 71 An (Hff=SHTI\5/90 1 <br />