Laserfiche WebLink
y <br /> N iY PUBLIC HEALTH SERYiCES/ENV[RONMENT71 <br /> A. HEA tVISTON <br /> SAN IOAQUI RTE — <br /> 1 UGST WORKSHEET FOR SITE CLOSURE EVALUATION <br /> AHE OF FACILITY ���� EPS CODE CU(P <br /> nDRESS � f Gt/eS� CC/Y ANK IO # 3 <br /> [ANK SIZE /p 61�t UEL'TYPE <br /> 11. GENERAL SITE HISTORY <br /> Is permit current7 esof ermit 9 - acility Status Code oe.Sai VGW Cant es a <br /> unber of Janks at facility ge of Tanks0 f available) ype of sank tee! ting{ ngl Dual <br /> 1[I. TANK HISTORY <br /> is Tank tested? es o ailed precision test 7 as o It f yes, give date(s) <br /> Jas a repair made to the tank'system? es Na 11f yes, what was repaired? <br /> as repair done under inspection7 es qo ere soil samples analyzed? es o TXE PH-G PH-D b/EDB <br /> I <br /> ype of failure/discharge atastroph'ic long-tern leakage verfilt known lacher: I <br /> TV. REMOVAL HISTORY (ATTACH INSP CTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> oil Samples Received e a epth to Ground Water of/Year verage Annual Precipitation = 4 0-25 <br /> -Site Will(S) es a umber & Type irr om ub <br /> S Score S Score S core <br /> {stance to Wel[(s) from Tank ft; ft; ft C 10 pts C 9 pts C Pts <br /> 0 if 0 if 0 f <br /> R ondition R condition R ondition <br /> Site Feature - Leaching Potential Analysis E is met E is met E s met <br /> inimum Depth to groundwater from the Soil Sample tfeet)ie—yo >100 1.100 -5 25-50\1 <br /> ractures in subsurface (applies to foothills or mountain areas) O None Unknown resent <br /> verage Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> f leachate (i.e., septic systems, water wells, pands) Yyldyr� Nana, Unknown 5 Dresent <br /> pique site features: Recharge area, coarse soil, nearby wells. At leastore than <br /> xxx <br /> xx None one one <br /> COLUMN TOTALS>»TOTAL POINTS j� + <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 I T X E B JT X E <br /> MAXIMUM ALLOWABLE 8-T-X-E LEVELS (PPM) 1' 50 50 50 j..3 .3 1. 1. HA\3 <br /> ample Result: SOLINE 1000 100 10 <br /> TPM D 3,000 yr4 �AXIMUM ALLOWABLE TPH LEVELS (FPM) <br /> 4pil 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 sail 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 natta TPH concentration of 10 ppz (gasoline) or 100 ppm (diesel). <br /> Vi. STAFF RECOMMENDATION/CONCLUSION Jti,�aCc. �lI—Ire -r 74��. <br /> 1. Are BTX &. E or TPH Concentrations > All able Leveis Yes <br /> Y <br /> 2. Recommend Site C[asure es a If Yes, Refer to Site Mitigation for Eva[uatien <br /> VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE ES 0 EFERRED TO SITE MITIGATION FOR EVALUATION fES O <br /> ATE REFERRED t / ATE CLOSURE LETTER MAILED f <br /> TAME OF <br /> ;VALUATOR <br /> j_ <br /> CH 23 80 (UCTWKSHT)\5/90 <br />