FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

pp � SAN JOAQUIN COUNT"`'JBLIC HEALTH SERVICES/ENVIfRONMENTAL HEALTH NIVISION 7 UG� ..rjRKSHEET FOR SITE CLOSUREI EVALUATION J DATE 1 159k NAME OF FACILITY O i + SWEEPS CODE �1� ADDRESS TANK ID >Y TANK SIZE r�a0� FUEL TYPO Ii, GENERAL SITE HISTORY *** 4 Is permit current? Yes No Permit ft - Facility Status EfT.njkSteet D .Soil/ Cont Yes No Number of Tanks at facility lo- 0( Age of Tanks(if available) �b Type Fbrgl sngl Dual ': P III. TANK HISTORY Was Tank tested? Yes No Failed precision test 7 Yes No It yes, give date(s) was a repair made to the tank system? Yes No 7 If yes, what was repaired? j', Was repair done under inspection? Yes No Were soil samples analyzed? Yes No STXE k TPH-G TPH-D k Pb/EDB Type of failure/discharge catastrophic long-term lefiil unknown other: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) - Soil Samples Received Yes h No Depth to Ground water �S Ref/Year �� ; Average Arcual Precipitation A 14 0-25 Y } On-Site Wells) Yes NO vl Number & Type Irr Dom Pub 5 Score S Score S Score i Distance to wells) from Tank ft; ft; ft C 10 pts C 9 pts ''I" 0 ifpts r 0 if O if R condition R condition R condition V. site Feature - Leaching Potential Analysis E is met E is met ' E is met o Minimum Depth to groundwater from the Soil Sample (feet} >100 51-1D0 25-5D\1 I Fractures in subsurface (applies to foothills or mountain areas) p None PowIn Present ' Average Annual Precipitation (inches) xxxxxx <1D 9 xxxxxxx 26-40\2 i 4 Man-Made conduits which increase vertical migration O None Unknown Present " of leachate (i.e., septic systems, .water welts, ponds) f At least =Korehan Unique site features: Recharge area, coarse soil, nearby wells. xxxxxx None one one COLUMN TOTALS»>TOTAL POINTS ZO + + M1 _ Sample Result: (!3 T % OR E) RANGE OF TOTAL POINTS49 pts or more 41 - 48 pts 40 pts or less l 1131 T X E S T X E /U� �� _ KAXIKUM ALLOWABLE B-T-X-E LEVELS (PPK); 1 50 5D 50 .3 .3 1. 1. NA\3 r Sample Result: GASOLINE 1000 100 10 MAXI" ALLOMLE TPH LEVELS (PPM) TPH DIESEL i 10,OOD 1000 100 } FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potential y analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) \1 If depth is > 5 ft. and < 25 ft., scare 0 points.ilf depth <=5 ft., do not use table. \2 If precipitation is > 40 inches, score 0 points. ppm ppm (diesel). \3 Levels for BTX&E are not applicable at a TPH concentration of 10 (gasoline) or 100 VI. STAFF RECCMKENDATION/CONCLUSION . F t. Are BTX & E ar TPH Concentrations Allowable Levels *Yes N0 2. Recommend Site Closure Yes No *If Yes, Refe to Site Mitigation for Evaluation VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/ NIOR k � CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YESNO REFERRED, TO SITE MITIGATION FOR EVALUATION YES NO DATE REFERRED / / DATE CLOSURE LETTER MAILED J I NAME OF EVALUATOR EH 23 80 (UGTWKSHT)\5/90 i i