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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME UST WORKSHEET FOR SITE CLOSUR NT ;ILITY/TANK INFORMATION E EVALUATION ;FACILITY NAME: Car CRESS: 6230 Pacific Ave /� FA0003624 .NK SIZE: 6,000 GENERAL SITE HISTORY Car Wash PR#: PR0231225 FUEL TYPE: Diesel DATE: 03/09/2021 STATUS CODE: CITY: Stockton TANK # 39-10181251-003 Permit Current? Q Yes ❑ No ❑ NA Documented Soil/GW Contamination?*** 'umber of Tanks at Facility 4 Age of Tanks (if available) 27 yrs Type of Tank QSteeISQFibe�glass ❑Sin le '. TANK HISTORY ❑Dual g 'as Tank Tested? �s ❑No ❑ NA Failed Testing? ❑Yes �(y�Io ❑ NA as Tank System Repaired? ❑Yes Q No ❑ NA If Yes Desc 'b If Yes, Provide Dates: rt e Repatr. �s Repair Done Under Permit? ❑Yes ❑ No Q NA Were Soil Samples Analyzed? Q Yes ❑ �e of Failure/Discharge: ❑Catastrophic ❑Long-term Leak ❑Overfill Q Unknown ❑ Ofher No REMOVAL HISTORY (Attach File — I Samples Received? Q Yes ❑ No Seasonal High De th t G an or Nearby Well(s)? ❑Yes Q No ❑Irrigation: # Distance to Tank ❑ Domestic: # ft Distance to Tank ft ❑Public: # Distance to Tank ft �s t t rtATURE –LEACHING POTENTIAL ANALYSIS rium Depth to Groundwater from Soil Sample (feet) Tures in Subsurface (applies to foothill or mountain areas) age Annual Precipitation (14 inches for SJC area) Made Conduits which Increase Vertical Migration e tic s stems, water wells ponds) �e Site Features. Recharge Area, Coarse Soil (coarse sands, Ise nearby wells in Totals mple Results for BTEX: � 1 � � ETZ'�T��li n le R It Q BTEX ❑TPH-G Q TPH-D ❑LEAD ❑EDB Q OTHER: VOLS ❑OXYGENATES Year/ Reference I Fall 2015 S S C Score 10 0 points if C R condition is 0 E met R E >100 10 Total Points � 10 None g <10 g None g None + � 27 Score 9 S points if C condition is 0 met R E 51-100 GJ Unknown 10 – 25 ________ Unknown At Least One Range of Total Points 49 Points or More 41– 48 Points Maximum Allowable BTEX B T E X B T E Levels (ppm) 1.0 50 50 50 0.3 0.3 1. X 0 1.0 Score 5 points if condition is met 25 - 50� Present 26 - 402 Present More Than One � `� _ �2 40 Points or Less N/A3 p esu s for TPH: Maximum Non -Detected Allowable TPH Gasoline 1,000 100 10 Levels pm Diesel 10,000 �: *** If documented soil and/or groundwater contamination is present, do not complete leachin 1,000 100 � 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. g potential analysis (i.e. site is already on the contamination list). s Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. FF RECOMMENDATION/ REFERRAL/ REVIEW TEX or TPH Concentrations > Allowable Levels? 'Yes �No 2 If N I ' 'd By; Vicky Vang-Lee sure Letter 180 (Rev 11/14/08) • o, s Site Closure Recommended? Date Referred to Site Mitigation Unit for Final Actiont Yes ❑ No Concur with Staff Recommendation Yes ❑ No tAll Cases are Referred to Site Mitigation for Final Action p o W. 40 ft bgs �ite d/ an or Nearby Well(s)? ❑Yes Q No ❑Irrigation: # Distance to Tank ❑ Domestic: # ft Distance to Tank ft ❑Public: # Distance to Tank ft �s t t rtATURE –LEACHING POTENTIAL ANALYSIS rium Depth to Groundwater from Soil Sample (feet) Tures in Subsurface (applies to foothill or mountain areas) age Annual Precipitation (14 inches for SJC area) Made Conduits which Increase Vertical Migration e tic s stems, water wells ponds) �e Site Features. Recharge Area, Coarse Soil (coarse sands, Ise nearby wells in Totals mple Results for BTEX: � 1 � � ETZ'�T��li n le R It Q BTEX ❑TPH-G Q TPH-D ❑LEAD ❑EDB Q OTHER: VOLS ❑OXYGENATES Year/ Reference I Fall 2015 S S C Score 10 0 points if C R condition is 0 E met R E >100 10 Total Points � 10 None g <10 g None g None + � 27 Score 9 S points if C condition is 0 met R E 51-100 GJ Unknown 10 – 25 ________ Unknown At Least One Range of Total Points 49 Points or More 41– 48 Points Maximum Allowable BTEX B T E X B T E Levels (ppm) 1.0 50 50 50 0.3 0.3 1. X 0 1.0 Score 5 points if condition is met 25 - 50� Present 26 - 402 Present More Than One � `� _ �2 40 Points or Less N/A3 p esu s for TPH: Maximum Non -Detected Allowable TPH Gasoline 1,000 100 10 Levels pm Diesel 10,000 �: *** If documented soil and/or groundwater contamination is present, do not complete leachin 1,000 100 � 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. g potential analysis (i.e. site is already on the contamination list). s Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. FF RECOMMENDATION/ REFERRAL/ REVIEW TEX or TPH Concentrations > Allowable Levels? 'Yes �No 2 If N I ' 'd By; Vicky Vang-Lee sure Letter 180 (Rev 11/14/08) • o, s Site Closure Recommended? Date Referred to Site Mitigation Unit for Final Actiont Yes ❑ No Concur with Staff Recommendation Yes ❑ No tAll Cases are Referred to Site Mitigation for Final Action