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SAN JOAQUIN C*--Y PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEAL,,-/OIVISION <br /> I• UGST WORKSHEET FOR SITE CLOSURE EVALUATION ATE <br /> NAME OF FACILITY �,� T- r f SWEEPS CCOE <br /> OORE55TANK IO <br /> ANK SIZE 5,o0 UEL TYPE �(P�a /T G <br /> II. GENERAL SITE HISTORY <br /> ww <br /> Is permit current? cs o ermit a acility Status Code oc.SoillGW Cone IYes o <br /> umber of Tanks at facility ge of Tanks(if available) ype of Tank teel Fbrgl ng Ouat <br /> III. TANK HISTORY <br /> ns Tank tested? Ifes X a ailed precision test ? Ires o If yes, give date(s) <br /> as a repair made to the tank system? Ires Na 11f yes, what was repaired? <br /> as repair done under inspection? Ifes a Pere soil samples anatyzed? es to TxE114 PH-G PH-o b/E0B <br /> Yoc of failureldischarge atastrophic long-term Leakage verfitt nknown I locher: <br /> IV. PEMOVAL HISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT DATA FOR LEACHING POTENTIAL ANALYSIS) <br /> .oil Samples Received es )(INC epth to Ground Water �j of/Year verage Annual Precipitation <br /> Dn-Site Well s) es o umber & Type Err om b a <br /> S core S Score S core <br /> ;stance to Wells) frau tank ft; ft; ft C 0 pts C 9 pts C pts <br /> 0 f 0 if 0 f <br /> R onditicn R condition R ondition <br /> Site Feature - Leaching Potential Analysis s met £ is met E s met <br /> inimum Depth to groundwater from the Soil Sanpte (feet) (' �S Z� >100 1-100 25-50\1 <br /> Fractures in subsurface (applies to foothills or mountain areas) /�•� None Unknown resent <br /> verage Annual Precipitation (inches) t xxxx <10 9 10.25 xxxxxxx 26-40\2 <br /> an-Made conduits which increase vertical migration <br /> f teachate (i.e., septic systems, water welts, ponds) �'.' None Unknown resent <br /> Inique site features: Recharge area, coarse soil, nearby wells. At Least 4ore than <br /> xxxx None one one <br /> -71 <br /> �� T <br /> COLUMN TOTAL TOTAL POINTS 4 <br /> Sample Result• T X_OR E RANGE OF TOTAL POINTS 9 pts or more 41 - 48 pts 40 pts or less <br /> er <br /> S T X E 9 T X <br /> ` F MIAXIMLiM ALLOWAaLE 3-T-x-E LEVELS (PPM) 1 50 50 50 .3 .3 1. 1. NA\3 <br /> ampte Resuil: ff f SOLTNE 1000 100 10 <br /> (v <br /> —� )O M AXIMUM ALLOWABLE TPH LEVELS (PPM) <br /> TPH 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 UCT Contamination List for soil or ground water.) <br /> \1 if depth is > 5 ft. and < 25 ft., score 0 points. If depth c=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 RECOMMENOATION/CONCLUSION <br /> 1. Are 3TX & E or TAH Concentrations > Altawable Levels Yes o V 'LL1`1/lJ <br /> 2. Recommend Sire CtosureFTo If Yes, Refer to Site Mitigation for Evaluation �U <br /> VTI. REVIEW EVALUATION TO HE COMPLETED BY A SUPERVISOR/SENIOR <br /> CNCUR WITH STAFF RECOMMENOATICN FOR CLOSURE YES I EFERRED TO SITE MITIGATION FOR cVALUATION �rES �10 <br /> ATE REFERRED / / ATE CLOSURE LETTER MAILED <br /> AME :.F <br /> .VALUATCR <br /> 1", <br /> EH 23 30 (UGTWXSHT)\5/90 <br /> =d 29 10 <br />