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SAN JOAGUIN CCUNTY C HEALTH SERVICES/ENVIRONMENTAL HEALTH DI' IN <br /> UGST Wt ,HETET FOR SITE CLOSURE EVALUATION *--' ATE <br />"E OF FACILITY y�Js� �� �. r / 1 EEPS CODE <br /> DRESS I � In c 14(-k— AHK to x 2 2-1 "D <br /> NK SIZ° UEL TYPE <br /> GENERAL SITE HISTORY <br /> permit current? es o ermit IFacitity Status Code oc.Soil/GW Cont IYes 10 <br /> inner of Tanks at facility Se of Tanks(if available) yp- of Tank teat brgl ngl Oua( <br /> TANK ' 1 STORY <br /> s Tank :esced? as a Faited precision test ? es a If yes, give date(s) <br /> is a repair made to the tank system? IYes N0 I IIf yes, what was repairedl <br /> is repair done under inspection) yl es No Mere soil samples analyzed? � es to TXIE PH-G. PH-D b/EOG <br />,cc of faiture/discharge acastrophic long-term teakage verfitl I noun la cher: <br /> REMOVAL iISTORY (ATTACH INSPECTION REPORT FOR SITE DETAILS/COLLECT :ATA FOR LEACHING POTENTIAL ANALYSIS) <br /> 7iL Samotes Received es Ino epch to Ground 'water Ito of/Year 8� ; verage Annuat Precipitation km 4 10.25 <br /> i-Si:e 'aell(s) 4 s o unbar b Type Irr an b <br /> S core S care 5 score <br />'stance :o 'welt(s) from Tank ft; ft; ft C 0 pts C 9 pts C pts <br /> O f 0 if 0 f <br /> 2 "ition R ondition R ondition <br /> Si!e Feature - Leaching Potential Analysis rs met E is met E s met <br /> inimum Depth to groundwater from the Soil Sampte (feet) I �100 1-100 -� 25-50\1 <br />-actures in sutsurfaca (applies to foocnills or mountain areas) None Unknown resent <br /> ecrage Arcual Precipitation (inches) rxxxxx I CIO 9 10-25 xxxxxxx 26-40\2 <br /> in-mace conduits which increase vertical migration <br /> f teachate (i.e., septic systems, water watts, ponds) None " Unknown resent <br />,ique site; features: Recharge area, coarse soil, nearby welts. At least are than <br /> xxxx Nona We � one <br /> COLUMN TOTALS»>TOTAL POINTS . 5 + o I <br /> ale Result: (a T X OR E) RANGE OF TOTAL POINTS 9 pts or more I 41 - 4a ,pts 40 pts or_ s <br /> `" $ T X c 3 T X \ <br /> r � MAXIMUM ALLOWABLE a-T-X-. LEVELS (PQM) 1 50 50 50 I .3 .3 11. 1. NA\3 <br /> amole Result: OLIVE 1000 100 10 <br /> 0^' 4AXIMUK ALLCWA8L.E TPM LEVELS (PPM) <br /> 'j <br /> L W TPH rlESEL 10,000 1000 100 <br />.OTNOT=-S: *"If documented soit and/or ground water contamination is present. ea not complete the leaching potential <br /> un <br /> analysis. (i.e., site is currently an UGT Contamination List for Soit or ground water.) <br /> %l If depth is :- 5 ft. and < 25 ft., score 0 points. If aepch <=i ft., do not use table. <br /> \2 If precipitation is > 40 inches, score a points. <br /> \3 Levels for STM are not applicable at a TPH concentration of to ppm (gasoline) or 100 ppm (diesel). <br /> STAFF RECOIMENOATION/CCNCLUSICNI <br /> i <br /> 1. Are 3TX 3 iE or TAH Concentrations Alloweble levels Ycs �0 ' 1 <br /> 2. Recominend Site Closure es I o ✓ If Yes, Refer to Site Mitigation for Evaluation <br /> IEVIEW EVALUATION - TO 3E =IPLETED 3Y A SUPERVISOR/SENIOR <br /> ZONCUR WITH STAFF RECOMMENDATION FOR CLOSURE E5 1140 1 EFERRED TO SITE HLTIGATICN FOR "EVALUATION tES !4O I _j <br />)ATE RE� �,AiE CLOSURE LETTER MAILED i <br /> i <br />