Laserfiche WebLink
SAN JOACUIN COUNTY HEALTH SERVICES/ENVIRONMENTAL HEALTH 00 <br /> UCSi XSHEET FOR SITE CLOSURE EVALUATION ATE —f <br /> )LAME Of FACILITY U EPS COOS l <br /> DRESS <br /> ANz to x - <br /> TANX SIZE tWEL TYPE /e <br /> i. GENERAL SITE HISTORY <br /> OD <br /> Is permit current? es o ermit x acility Status Code oc.Soit/GW Cont es o <br /> unber of Tanks at facility ge of Tanks(if available) ype of Tank teel VlFbcgt ngI DueL <br /> II. TANX HISTORY <br /> as Tank tested? es o lFaited precision test ? as o if yes, give date(s) <br /> Jos a repair made to the tank system? tyes No f yes, what was repaired? <br /> ':ns repair done under inspection? es I Rol dere soil samples analyzed? es o TXE PH-G PH-0 I b/E08 <br /> ype of failure/discharge atastrophic long-term Leakage verfitl cher: <br /> f. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received as o epth to Ground Vater of/Year ; verage Annual Precipitation 4 0-25 <br /> -Site 'Jett s) es o unber b Type Irr L om I b <br /> S Score S Score S core <br /> istance to Welt(s) from Tank ft; ft; ft C 10 pts C 9 pts C pts <br /> o If 0 if 0 f <br /> R Condition R condition R ondition <br /> Site Feature - Leaching Potential Arnalysis E I is met E is met E is met <br /> Minimum Depth to groundwater from the Soil Saapte <feet) >100 1-100 25-50\1 <br /> ractures in subsurface (applies to foothitts or mountain areas) None Unknown resent <br /> �vcrage Annual Precipitation (inches) xxxx 00 9 10-25 xxxxxxx 26-40\2 <br /> .an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> Jnique site features: Recharge area, coarse soil, nearby wells. At least 4ore than <br /> xxx None one cone <br /> COLUMN TOTALS>>)-TOTAL POINTS <br /> ample esutt: (8 T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or T1ess <br /> B 1 T X E B 7 X E <br /> \( ® MAXIMUi ALLOWABLE B-T•X-E LEVELS (PPM) 1 5A 50 SO .3 .3 1. 1. NA\3 <br /> u <br /> Sample Result: r1F <br /> IVE 1000 100 10 <br /> IMUM ALLOVABCE TPN LEVELS (PPM) <br /> PH L 10,000 1000 100 <br /> FOOTNOTES: ***If documented soit and/or ground water contamination is pre:ene, do not complete the leaching pocentiat <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 4=5 ft., do not use table. <br /> \2 If precipitation is > 40 inches, score 0 points. <br /> \3 Levels for BTX&E are not applicable at a TPN concentration of 10 ppa (gasoline) or 100 ppm (diesel). <br /> '.. STAFF RECCfMIEMOAT ION/CCNCLUSION <br /> 1. Are 3TX *x E or TPH Concentrations > Altowabte Levels Yes o <br /> 2. Reccmmerd Site Ctosure yes I o tf Yes, Refer to Site Mitigation for Evaluation <br /> 'I. REVIEW EVALUATION - TO BE CCMPLETEO BY A SUPERVISOR/SENIOR <br /> OHCUR WITH STAFF RECCHMENDATtON FOR CLOSURE ES EFERREO TO SITE AITICATICH FOR EVALUATION ES 0 <br /> ATE REFERRED ! / ATE CLOSURE LETTER MAILED T ' f / <br /> TAME OF <br /> ;VALUATOR <br /> EH 23 aO (UG MSHT)\5/90 <br />