COMPLIANCE INFO_1998-2006 - Laserfiche WebLink

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I. NAME OF FACILITY ADDRESS TANK SIZE II. GENERAL SITE HISTORY SAN JOAQUI TY PUBLIC HEALTH SERVICES/ENVIRONMENTAL DIVISION ST WORKSHEET FOR SITE CLOSURE EVALUATION 17—.�Y-97 — ' SWEEPS CODEI TANK I0 Is permit current? Yes No NO Permit # - Facility Status Codeln l Doc-Soil/GW Cont Yes No If Number of Tanks at facility 14 Age of Tanks(if available) Yes Type of TanklSteel Tom.. Fbrgl as Sngl Dual Were soil samples analyzed? I1I. TANK HISTORY Was Tank tested? Yes NO NoFailed REFERRED TO SITE MITIGATION FOR EVALUATION precision test ? Yes No If yes, give dates)' 14 Was a repair made to the tank system? Yes No If yes, what was repaired? Tom.. Was repair done under inspection? as Number & Type No Were soil samples analyzed? Yes No BTXE TPN -G TPN -D Pb/EDB Type of failure/discharge S catastrophic S C 0 R E long-term leakage S C 0 R E overfill Distance to Well(S) from Tank unknown R other: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) Soil Samples Received Yes YES NO No REFERRED TO SITE MITIGATION FOR EVALUATION Depth to Ground WaterRef/Year NO to Average Annual Precipitation A= 14 10-25 On -Site Wells) Yes No Number & Type Irr Dom Pub S Score 10 pts if condition is meet S C 0 R E Score 9 pts if condition is met S C 0 R E Score 5 pts if condition is met Distance to Well(S) from Tank ft; ft; ft C 0 R V. Site Feature - Leaching Potential Analysis E Minimum Depth to groundwater from the Soil Sample (feet)50 — >100 1 51-100 I 25-50\1 Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present Average Annual Precipitation (inches) xxxxxx <10 9 10-25 (xxxxxxx 26-40\2 Man -Made conduits which increase vertical migration of leachate (i.e., septic systems, water wells, ponds) None Unknown Present Unique site features: Recharge area, coarse soil, nearby wells. xxxxxx None At least) one More than one COLUMN TOTALS>>>TOTAL POINTS I * + Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more �^ E ze 10 1 B T X E rP144; —A) 'Os J ' MAXIMUM ALLOWABLE B -T -X -E LEVELS (PPM) 1 50 50 50 41 - 48 pts 40 pts or less B .3 T .3 X 1. E 1. NA\3 Sample Result: TPH GASOLINE MAXIMUM ALLOWABLE TPH LEVELS (PPM) DIESEL 1000 100 10 10,000 1000 100 FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potential analysis. (i.e., site is currently of UGT Contamination List for soil or ground water.) \1 if depth is > 5 ft. and < 25 ft., score 0 points. If depth c=5 ft., do not use table. \2 If precipitation is > 40 inches, score 0 points. \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). P'T' VI. STAFF RECOMMENDATION/CONCLUSION 1. Are BTX & E or TPM Concentrations > Allowable Levels *Yes No 2. Recommend Site Ctosure Yes No *If Yes, Refer to Site Mitigation for Evaluation VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO DATE REFERRED / / DATE CLOSURE LETTER MAILED NAME OF EVALUATOR EH 23 80 (UGTWKSHT)\5/90