COMPLIANCE INFO_1986-1999 - Laserfiche WebLink

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Atm SAN JOAQUIN Y PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE.W. DIVISION �. UGST WORKSHEET FOR SITE CLOSURE EVALUATION DATE l NAME OF FACILITY SWEEPS CODE y ADDRESS TANK ID7# TANK SIZE FUEL TYPE GENERAL SITE -HISTORY V v *** permit current? Yes No Permit # - Facility Status Code Doc.Soil/GW Cont Yes No mer of Tanks at facility Age of Tanks(if available) Type of Tanjk Steel Fbrgl Sngl Dual III. TANK HISTORY Was Tank tested? Yes No Failed precision test ? Yes Ref/Year No If yes, give date(s) 14 Was a repair made to the tank system? Yes No Yes If yes, what was repaired? / j Was repair done under inspection? Yes No Irr Were soil samples analyzed? Yes No BTXE iiT H -G Score 9 pts if condition is met TPH -D Score 5 pts if condition is met Pb/EDB ft; ft; ft C 0 e Type of failure/dischargatastrophic V. Site Feature - Leaching Potential Analysis E c long-term leakage overfill unknown Fractures in subsurface (applies to foothills or mountain areas) other: IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA POR LtALnaNv ruieRILAL ARAB--l-I Soil Samples Received Yes No Depth to Ground Water Ref/Year Average Annual Precipitation A= 14 10-25 On -Site Wells) Yes No Number & Type Irr Dan Pub S Score 10 pts if condition is met S C 0 R E Score 9 pts if condition is met S C 0 R E Score 5 pts if condition is met Distance to Well(S) from Tank ft; ft; ft C 0 R V. Site Feature - Leaching Potential Analysis E Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 Man -Made conduits which increase vertical migration of leachate (i.e., septic systems, water wells, ponds) None Unknown Present Unique site features: Recharge area, coarse soil, nearby wells. xxxxxx None At least one More than one COLUMN TOTALS>>>TOTAL POINTS + + = Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more B T X E MAXIMUM ALLOWABLE B -T -X -E LEVELS (PPM) 1 50 50 50 41 - 48 pts 40 pts or less B .3 IT .3 I X 1. E 1. NA\3 Sample Result: TPH MAXIMUM ALLOWABLE TPM LEVELS (PPM) GASOLINE 1000 100 10 DIESEL 10,000 1000 100 FOOTNOTES: ***If documented soil and/or ground water contamination is present, do not complete the leaching potential analysis. (i.e., site is currently on UGT Contamination List for soil or ground water.) \1 If depth is > 5 ft. and < 25 ft., score 0 points. If depth <=5 ft., do not use table. \2 If precipitation is > 40 inches, score 0 points. \3 Levels for BTX&E are not applicable at a TPM concentration of 10 ppm (gasoline) or 100 ppm (diesel). VI. STAFF RECOMMENDATION/CONCLUSION 1. Are BTX & E or TPH Concentrations > Allowable Levels *Yes No 2. Recommend Site Closure Yes No *If Yes, Refer to Site Mitigation for Evaluation VII. REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/SENIOR CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YES NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO DATE REFERRED / / DATE CLOSURE LETTER MAILED NAME OF EVALUATOR EH 23 80 (UGTWKSHT)\5/90