Laserfiche WebLink
SAN JOAQUIN CO' PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAL IVISION <br /> I L� WORKSHEET FOR SITE CLOSURE EVALUATION %.O� DATE <br /> NAME OF FACILITY J SWEEPS CODE <br /> o <br /> ADDRESS 'TANK ID # 3 - SI�C 736 <br /> TANK SIZE J FUEL TYPE u jj itµ <br /> II. GENERAL SITE HISTORY <br /> Is perm=", Yes Nv Permit # Facility Status Code Doc.SoiL/GW Cont Yes No <br /> Number of Tanks at facility Age of Tanks(if available) ? Type of Tan Stee Fbrgl Sng Dual <br /> III. TANK HISTORY <br /> Was Tank tested? Yes No Failed precision test ? Yes No If yes, give date(s) <br /> Was a repair made to the tank system? Yes No If yes, what was repaired? <br /> Was repair done under inspection? Yes No Were soil samples analyzed Yes No BTPH TPH D Pb/EDB <br /> Type of faiture/discharge catastrophic long-term leakage overfill unknow other: 011 b e-440-11^ <br /> IV. REMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> Soil Samples Received es No Depth to Ground Water WRef/Year 1/9 g 6; Average Annual Precipitation A= 14 10 25 <br /> On-Site Wells) Yes No - Number & Type Irr Dom Pub P <br /> 5 Score S Score S Score <br /> Distance to Well(s) from Tank 7 ft; ? ft; T ft C 10 pts C 9 pts C 5 pts <br /> 0 if 0 if 0 if <br /> R condition R condition R condition <br /> V. Site Feature - Leaching Potential Analysis E is met E is met i E is met <br /> Minimum Depth to groundwater from the Soil Sample (feet) >100 51-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) None Unknown Present <br /> Average Annual Precipitation (inches) xxxxxx <10 9 10-25 xxxxxxx 26-40\2 <br /> Man-Made conduits which increase vertical migration <br /> of leachate (i.e., septic systems, water wells, ponds) None Unknown Present <br /> Unique site features: Recharge area, coarse soil, nearby wells. At least More than <br /> xxxxxx None one one <br /> COLUMN TOTALS>>>TOTAL POINTS + + r " = '33 <br /> Sample Result: (B T X OR E) RANGE OF TOTAL POINTS 49 pts or more 41 - 48 pts opts or less <br /> Icy l-"4 so 5-0"0,7 <br /> B T X E B T X E <br /> �Zyce '(0/ls�X`f MAXIMUM ALLOWABLE B-T-X-E LEVEIS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> Sample Result: GASOLINE 1000 100 10 <br /> V--7'f MAXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> ! M TPH DIESEL 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 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 /> VI. STAFF RECOMMENDATION/CONCLUSION <br /> E <br /> Are BTX & E or TPH Concentrations > Allowable Levels *Yes <br /> Recortmend site Closure Yes Ho *If Yes, Refer to Site Mitigation for Evaluation <br /> I REVIEW EVALUATION - TO BE COMPLETED BY A SUPERVISOR/ ENIOR <br /> CONCUR WITH STAFF RECOMMENDATION FOR CLOSURE YE5 NO REFERRED TO SITE MITIGATION FOR EVALUATION YES NO <br /> DATE REFERRED a / / DATE CLOSURE LETTER MAILED <br /> NAME OF <br /> EVALUATOR <br /> EH 23 80 (UGTWKSHT)\5/90 <br />