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SAN JOACUIN C. ,Y PUBLIC HEALTH S"c2V1C5SIE4VIRCHW.E14TAL HEAL :VISION <br /> I, UGS7 GCRKSNEET FCR SITE CLOSURE EVALUAiICN DAFE ll' <br /> AME OF FACILITY 5;�7 SWEEPS CODE lb`b <br /> OGRESSY ANC 10 1 C16 - u r <br /> [ANX SIL � UEL TYPE �Q <br /> 11. C'cN£:2AL SITE HISTORY <br /> Is permit current? es / o ermit.# - Q�] l�f acitity Status Code �� ot.SaillGa Cant es o <br /> weber af Tanks at facility I ge of T nks(if avaitabLe) ype of Tank Leel brgl t+gt Oual <br /> [If. TANK HISTCRT - <br /> Jas Tank tested7 es o aited.precision test-7- es a X. 1f yes, give date(s) <br /> as a repair made to the tank system? es No 11f yes, what was repaired? <br /> 'as repair done under-inspection? es a ere soil samptes analyzed? es o TXE PH-G PH-0 b/EOBI <br /> ype of faiture/discharge acastrophic tong-term Leakage verfi[L known lother: <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE OETA.ILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) " <br /> oil Samples Received es. o epth to Ground 'later 47 /Z of/Year frp �22 verage Arnuat Precipitation = 4 0-25 <br /> -Site Wett(s) es oumber b Type Irr cra ub 14 <br /> 5 core ¢ S Score ..S,. core <br /> istance to uett(s) from Tank ft; ft; ft C 10 pts C 9 PCs C pts - <br /> 0 f 0 if O f <br /> R ondition R condition R ondi clan w <br /> Site Feature - Leaching Potentiat Analysis , E is met E is•met E s met <br /> iniaum Depth to groundwater from the Soil Sample <feet) >t00 I I-100 25-50\l <br /> ractures in.subsurface Capplies to foothills or mountain areas) None Unknown >resent <br /> %vcraqe Amual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> Df Leachate (i.e., septic systems, water Netts, ponds) None Unknown resent <br /> icue site features:`" Recharge area, coarse soil, nearby welts. At !east l are than <br /> xxxx Hone ' one {I ane <br /> COLUMN TOTALS>>>TOTAL POINTS t <br /> ampt,e Re utt: (B T X OR E) RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pt5 or Iess <br /> 0_. 04Dops; f'..v�fP°`1 B T X E 8 T' I X" E <br /> MAXIMLti ALLOWABLE B-T-X-E LEVELS (PPM) 't• 50 50 50 .3 .3 1. t. NA\3 <br /> ample Resutt: SASOLTHE 1000 100 10 <br /> AXTMUM ALLOWABLE TPH LEVELS (PPM) <br /> Z 6 ! TPH-6- 3 IESEL 10,000 1000 1,00 <br /> COfH0TE5: <br /> *,*If documented snit 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 salt 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 /> '1. STAFF RECCWENOATION/CONCLUSION <br /> 1. Are BTX E or TPH Concentrations > Allowabte Levets Yes o <br /> 2. Recommerd Site Ctosure es o If Yes, Refer to Site )litigation for-Evaluation <br /> 'I I. REVIEW EVALUATICH - TO BE CCMPLETED BY A SUPERVISOR/SENIOR <br /> -CNCUR WITH STAFF RECCfiMENDATION FOR CLOSURE ES (] EFERRED TO SITE MITIGAT[CN FOR EVALUATION T:S O <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> LANE OF <br /> :VALUATOR <br /> EN 23 80 (UCTUXSHT)\5/90 <br />