Laserfiche WebLink
SAN JOACUIN CCUNTY LIC HEALTH SERVICES/EHVIRCHMENTAL HEALTH0' 'ION <br />UGS .XSHEET FOR SITE CLOSURE EVALUATICH ATE 9/ <br />:AME OF FACILITY1,�1� EEPS CODE `%,q� <br />`IORESS ��SO (f tC fop^ �( ANK ID 0 <br />tNK SIZE TYPE <br />GENERAL SITE HISTORY <br />** <br />permit current? es o ermit # - acitity Status Code ?51 oc.Soil/GU Cont es e <br />user of Tanks at facility kge of Tanks(if available) ype of Tank teel brgl ng1 Oual <br />TANK HISTORY <br />:is Tank tested? <br />es <br />o <br />o <br />epth to Ground slater <br />ailed precision test ? <br />es <br />�- ; verage Annual Precipitation <br />o <br />'AME OF <br />1ALUATOR <br />If yes, give date(s) <br />`n -Site tletl(s) <br />.is a repair made to the tank system? es No f yes, what was repaired? <br />-,s repair done under inspectioni <br />es 40 <br />ere soil samples analyzed? es <br />o <br />cm <br />TXE <br />ub <br />PH -G <br />PH -D <br />S <br />C <br />0 <br />R <br />E <br />b/EDB <br />-pe of failure/discharge <br />core <br />pts <br />'f <br />ondition <br />'s met <br />atastrophic <br />Long-term leakage <br />veHill <br />'linimum Depth to groundwater from the Soil Sample <feet) <br />known <br />>100 <br />cher: <br />REMOVAL HISTORY (ATTACH INSPECTION REPORT FCR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br />`oiL Samples Received es <br />ES <br />o <br />ES 0 <br />epth to Ground slater <br />S <br />of/Year <br />�- ; verage Annual Precipitation <br />'AME OF <br />1ALUATOR <br />`n -Site tletl(s) <br />es <br />o <br />umber & Type <br />irr <br />cm <br />ub <br />S <br />C <br />0 <br />R <br />E <br />Score <br />0 pts <br />if <br />onditicn <br />is met <br />S <br />C <br />0 <br />R <br />E <br />Score <br />pts <br />if <br />condition <br />is met <br />S <br />C <br />0 <br />R <br />E <br />core <br />pts <br />'f <br />ondition <br />'s met <br />. <br />kistanee to ueli(s) from Tank <br />ft; ft; ft <br />. Site Feature - Leaching Potential Analysis <br />'linimum Depth to groundwater from the Soil Sample <feet) <br />>100 <br />1-100 <br />25-50\1 <br />ractures in subsurface (applies to foothills or mountain areas) <br />None <br />Unknown <br />3resent <br />!0.verage Annual Precipitation (inches) <br />KXXXXX <br /><10 <br />9 <br />10-25 <br />xxxxxxx <br />26-40\2 <br />..n -Made conduits which increase vertical migration <br />J teachate (i.e., septic systems, water welts, ponds) <br />None <br />Unknown <br />resent . <br />niWe site features: Recharge area, coarse soil, nearby wells. <br />xxxx <br />None <br />At least <br />one <br />4ore than <br />one <br />COLUMN TOTALS»>TOTAL POINTS <br />+ <br />+ <br />"sample Result: (B T X OR E) <br />RANGE OF TOTAL POINTS <br />9 pts or more <br />- 41 48 pts <br />40 pts or less <br />MAXIMLki ALLOWABLE B -T -X -E LEVELS (PPM) <br />B <br />1 <br />1 T I <br />50 <br />X <br />50 <br />E <br />50 <br />B <br />.3 <br />JT <br />.3 <br />X <br />1. <br />E <br />1. <br />HA\3 <br />ample Result: <br />TPN <br />SASOLINE <br />AXIMUM ALLOWABLE TPN LEVELS (PPH) <br />IESEL <br />1000 <br />100 <br />10 <br />10,000 <br />1000 - <br />100 <br />'OTHOTES: ***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 soil 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 />STAFF RECCHMENDATION/CCNCLUSION <br />Are BTX &. E or TPH Concentrations > Allowable Levels Yes o <br />Recommend Site Closure es o If Yes, Refer to Site Mitigation for Evaluation <br />REVIEW EVALUATION - TO SE COMPLETED BY A SUPERVISOR/SENIOR <br />ONCUR WITH STAFF RECCHME4DATION FOR CLOSURE <br />ES <br />0 EFERRED TO SITE MITIGATION FOR EVALUATION <br />ES 0 <br />SATE REFERRED <br />/ / <br />ATE CLOSURE LETTER WAILED <br />'AME OF <br />1ALUATOR <br />f 23 80 (UGTWKSHT)\5/90 <br />