Laserfiche WebLink
C*SAN JOAOUIN C* PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAL TVISION <br /> I, UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> AME OF FACILITY f zazico rho] SWEEPS CODE <br /> OORESS E V11CJ> — 0i Lb TANK IO # <br /> LANK SIZE ZS�� UEL TYPE C-1'PS <br /> It. GENERAL SITE HISTORY <br /> Is permit current7 es I i4o Oermit # - acility Status Code oc.Soil/GW Cont es T-FT7 <br /> umber of Tanks at facility ge of Tanks(if available) IT ype of Tank Leet I Fbrgl ngl I Dual <br /> III. TANK HISTORY <br /> as Tank tested? es IN _oailed precision test 7 es o ff yes, give date(s) <br /> as a repair made to the tank system? 1Yes No I Af yes, what was repaired? <br /> as repair done under inspection7 es tj,�q o 1 ere soil samples analyzed? 1Y <br /> es o I TXE PH-G IT <br /> PH-D I 1Pb/ED8 <br /> ype of failure/discharge atastrophic long-term leakage verfill nknown 1 10ther: <br /> IV, REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es o epth to Ground Water � of/Year verage Annual Precipitation N= 4 0-25 <br /> n-Site Wetl(s) es o umber & Type Irr om ub <br /> S Score S Score S Score <br /> istance to WeLI(S) from Tank ft; ft; # ft C 10 pts C 9 pts C pts <br /> 0 if 0 if 0 f <br /> R condition R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E is met <br /> inimum Depth to groundwater from the Soil Sample (feet) >100 1-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown resent <br /> verage Annual Precipitation (inches) KXXXXX <10 9 10-25 xxxxxxx 26-40\2 <br /> Ian-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, ponds) None Unknown resent <br /> pique site features: Recharge area, coarse soil, nearby wells. At least lore than <br /> xxxx one one one <br /> COLUMN TOTALS»>TOTAL POINTS 6 + + 2,+ <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> B T X E B 7 X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> ample Result: SASOLINE 1000 100 10 <br /> AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH IESEL 10,000 1000 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 /> \3 Levels for BTX&E are not applicable at a TPH concentration of 10 ppm (gasoline) or 100 ppm (diesel). <br /> V1. STAFF RECOMMENDATION/CONCLUSION <br /> 1. Are BTX $ E or TPH Concentratio s > Allowable Levels Yes o <br /> 2. Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 <br /> RRED TO SITE MITIGATION FOR EVALUATION fES 0 <br /> )ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> JAME OF <br /> :VALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />