Laserfiche WebLink
SAN LIN COUNTY PUBLIC HEALTH SERVICES/EIVTRONMEI j HEALTH 01VISION <br /> I UST WORKSHEET FOR SITE CLOSUM EVALUA7 ATE <br /> AME OF FACILITYiI C y CPP,?J z), i.) 6417,,9- <br /> GCRfl fA <br /> DORESS 37 A Ca V I l/f' LANK IO I <br /> ANK SIZf I ( �5 o O ! TYPE 1Q <br /> [I. GENERA! SITE HISTORY <br /> Is permit current? es o ermit 4 - acility status Code oc.SoiLjGUCoant ;M;umber of Tanks at facility ge of Tank(if available) ype of Tank tee! br <br /> II[. TANK HISTORY <br /> as Tank tested7 es o ailed precision test ? es INO If yes, give date(s) <br /> as a repair made to the tank system? es No f yes, what was repaired? <br /> LS repair done under inspection? fes a ere soil samples analyzed? es a TXE PH-G PH-D h/EDg <br /> ype of failure/discharge aLang-term Leakage ill ther- <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) � <br /> ail Samples Received es a epth to Ground Slater O ef/Year �� verage ,annual Precipitation = 4 0-25 <br /> n-Site WeIL(s) es o umber & Type Irr on ; <br /> 5 core S care S. care <br /> istance to Wells) from Tank ft; ft; ft C 0 pts C pts C pts <br /> 0 'f O if 0 -f <br /> R cndition R ondition R anditian <br /> Site Feature - Leaching Potential Analysis E s met is met E -s met <br /> inimm Depth to grourdwacer from the Soil Sample (feet) >100 1-100 Z5-5a�1 <br /> ractures in subsurface (applies to foothills or mountain areas) j Hone <br /> Unknown- <br /> 10 <br /> verage Annual Precipitation (inches) t <10 9 10-25 z5-401Z <br /> an-Made conduits which increase vertical migration r <br /> f Leachate (i.e., septic systems, water wells, ponds) ] Nate q Unknown resent <br /> pique site features: Recharge area, coarse soil, or wails. At Least are than <br /> (MuncipaL=>2000 ft; domestic->500 ft; irr/agricuLturaL=present] xxxxxx Norte one one <br /> COLUMN TOTALS»>TOTAL POINTS 1 D + <br /> Ila- <br /> ample ResuLt: (B T X OR E) RANGE OF TOTAL POINTS 4 pts or more 41 - 4a pts /40 pts or less <br /> B T X E B T X E <br /> MAXIMUM ALLOWABLE B-T-X-E LEVELS (PPM) i 'So 50 50 .3 .3 1_ 1_ HA),3 <br /> ample Result: LINE 1000 100 10 <br /> Il�1M ALLOWABLE TPN LEVELS (PPM) <br /> TP„ IESEL 10,000 1000 100 <br /> OOTNOTES. "'''If documented sail and/or ground water contamination is present, do not complete the lea t r <br /> analysis_ 0.e-, site is currently on UGT Contamination List for soil or ground water.) <br /> L If depth is > 5 ft_ and < 25 ft., scare 0 points- if depth —5 ft., do not use table. <br /> L If precipitation is > 40 inches, scare II points. <br /> L Levels for STXBE are not applicable at a TPR concencraticn of 10 ppm (gasoline) or 100 ppm (diesel). <br /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> T. Are BTX & E or TPH Cancen=rations > Allowable Levels es o <br /> Z. Recaaiaend Site Closure es a If Yes, Refer to Site Mitigation for Evaluation y k <br /> V1 1. REVIE'a EVALUATION - TO 8E COMPLETED 8T A SUPERVISOR/LEAD SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES EFEiRED TO SITE MITIGATION FOR EVALUATION �ES O. <br /> ATE REFERRED i / / ATE CLOSURE LETTER MAILED <br /> i <br /> AME OF <br /> VALUATOR s <br /> EH 23 80 (UGTWKSHT)\5/44 <br />