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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UST WORKSHEET FOR SITE CLOSURE EVALUATION I . FACILITYITANK INFORMATION DATE : 7/16/2019 SITE/FACILITY NAME : ARCO 07049 STATUS CODE : ADDRESS : 800 E Kettleman Ln CITY: Lodi FA#: FA0003633 PR#: PR0231349 TANK # 39 10, 000 —gallon each TANK SIZE : 4 tanks total FUEL TYPE : Regular and Premium Unleaded II , GENERAL SITE HISTORY Is Permit Current? X Yes ❑ No ❑ NA Documented Soil/GW Contamination ?` ❑ Yes ,'o No Number of Tanks at Facility 4 Age of Tanks (if available) 1 /1 /1992 Type of Tank ❑ Steel OFiberglass ❑ Single ❑ Dual III . TANK HISTORY Was Tank Tested ? ,Yes ❑ No ❑ NA Failed Testing ? ❑ Yes N*( No ❑ NA Fif Provide Dates : Was Tank System Repaired? ❑ Yes 13 NoAA If Yes , Describe Repair: Was Repair Done Under Permit? ❑ Yes ❑ No ❑ NA Were Soil Samples Analyzed ? XYes ❑ No lIOTHER,\ G s: TPH-D 'Ll LEAD ❑ EDB 'EI. OTHER \ C ' s (] OXYGENATES Type of Failure/Discharge : ❑ Catastrophic ❑ Long-term Leak ❑ Overfill ❑ Unknown ❑ Other IV, REMOVAL HISTORY Attach File Soil Samples Received ? N Yes L1No Seasonal High Depth to GW : < 63ft Year/ Reference Well destruction report, GeoTrack , 2005 Onsite and/or Nearby Well (s) ? ❑ Yes �19No S S S ❑ Irrigation : # Distance to Tank ft C Score 10 C Score 9 C ❑ Domestic: # Distance to Tank ft 0 points if 0 points if 0 Score 5 points if ❑ Public: # Distance to Tank ft R condition is R condition is R condition is met V. SITE FEATURE — LEACHING POTENTIAL ANALYSIS E met E met E Minimum Depth to Groundwater from Soil Sample (feet) > 100 51 - 100 25 - 501 Fractures in Subsurface ( applies to foothill or mountain areas) None 9= Unknown Present Average Annual Precipitation ( 14 inches for SJC area) - < 10 9 10 — 25 - 26 - 402 Man- Made Conduits which Increase Vertical Migration None Unknown Present i . e . septic sstems , water wells , ponds Unique Site Features : Recharge Area, Coarse Soil (coarse sands , I None At Least One More Than One gravels) , nearbywells Column Totals Total Points ' ( ' + + Sample Results for BTEX: Range of Total Points 49 Points or More C 41 — 48 Points 40 Points or Less B rjI:> T ND Maximum Allowable BTEX B T E X B T E X 3 E N Levels (ppm) 1 . 0 50 50 50 0 . 3 0 . 3 0 1 . 0 N/A X ND Sample Results for TPH : Maximum Gasoline 11000 100 10 Allowable TPH Levels m Diesel 10 , 000 13000 100 Footnotes: ' "* If documented soil and/or groundwater contamination is present, do not complete leaching potential analysis (i.e. site is already on the contamination list) . If depth is >5 feet and < 25 feet, score 0 points. If depth is <=5 feet, do not use table. 2 If precipitation is > 40 inches, score 0 points. 3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. VI . STAFF RECOMMENDATION/ REFERRAL/ REVIEW 1 . Are BTEX or TPH Concentrations > Allowable Levels? ❑ Yes1j , No 2 . If No , Is Site Closure Recommended ?�,0 Yes ❑ No Completed By: Shewit Woldearegay Date Referred to Site Mitigation Unit for Final Actiont ' J/ Ak Reviewed By;', «� _ Concur with Staff Recommendation )(Yes ❑ No Date Closure Letter abiled tAll Cases are Referred to Site Mitigation for Final Action EH 23 -0080 (Rev 11 / 14/08)