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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />UST WORKSHEET FOR SITE CLOSURE EVALUATION <br />I. FACILITYITANK INFORMATION DATE: 03/0912021 <br />SITEIFACILITY NAME: Cane as Car Wash STATUS CODE: <br />ADDRESS: 6230 Pacific Ave CITY: Stockton <br />FA#: FA0003624 PR#: PR0231225 TANK # 39-10181251-004 <br />TANK SIZE: 6,000 FUEL TYPE: Premium Gasoline <br />. GENERAL SITE HISTORY <br />Is Permit Current? D Yes ❑ No ❑ NA <br />Documented SoiIIGW Contamination?*** ❑ Yes Q No <br />Number of Tanks at Facility <br />4 <br />Age of Tanks (if available) <br />27 yrs <br />Type of Tank QSteel QFiberglass ❑Single <br />❑Dual <br />III. TANK HISTORY <br />Was <br />Tank Tested? Yes ❑No ❑ NA <br />Failed Testing? ❑Yes 'I�NO ❑ NA <br />If Yes, Provide Dates: <br />Was <br />Tank System Repaired? ❑Yes Q No <br />❑ NA <br />If Yes, Describe Repair: <br />Was <br />Repair Done Under Permit? ❑Yes ❑ <br />No Q NA <br />Were Soil Samples Analyzed? Q Yes ❑ No <br />❑ BTEX D TPH-G ❑TPH-D Q LEAD ❑EDB <br />Q OTHER: VOCS ❑OXYGENATES <br />Type <br />of FailurelDischarge: ❑Catastrophic <br />❑Long-term Leak ❑Overfill D Unknown ❑Other <br />IV. REMOVAL HISTORY <br />Attach File <br />Soil Samples Received? D Yes ❑ No <br />Seasonal High Depth to GW: 40 ft bgs <br />Year/ Reference <br />Fall 2015 <br />Onsite and/or Nearby Well(s)? ❑Yes Q No <br />❑Irrigation: # Distance to Tank ft <br />❑Domestic: # Distance to Tank ft <br />❑Public: # Distance to Tank ft <br />� <br />O <br />R <br />E <br />Score 10 <br />points if <br />condition is <br />met <br />� <br />0 <br />R <br />E <br />Score 9 <br />points if <br />condition is <br />met <br />� <br />O <br />R <br />E <br />Score 5 points if <br />condition is met <br />V. SITE FEATURE —LEACHING POTENTIAL ANALYSIS <br />Minimum Depth to Groundwater from Soil Sample (feet) <br />>100 <br />51-100 <br />� <br />25 - 50� <br />Fractures in Subsurface (applies to foothill or mountain areas) <br />None <br />9 <br />Unknown <br />Present <br />Average Annual Precipitation (14 inches for SJC area) <br />-------- <br /><10 <br />9 <br />10 — 25 <br />-------- <br />26 - 402 <br />Man -Made Conduits which Increase Vertical Migration <br />i.e. se tics stems, water wells, onds <br />-------- <br />None <br />9 <br />Unknown <br />Present <br />Unique Site Features: Recharge Area, Coarse Soil (coarse sands, <br />ravels , nearb wells <br />10 <br />None <br />At Least One <br />More Than One <br />Column Totals Total Points <br />10 <br />+ <br />27 <br />+ <br />� <br />= L�2 <br />Sample Results for BTEX: <br />Range of Total Points <br />49 Points or More <br />41 — 48 Poin <br />40 Points or Less <br />B <br />T Nb� ���� "'�`�� <br />E � <br />X <br />Maximum Allowable BTEX <br />Levels (ppm) <br />B <br />1.0 <br />T <br />50 <br />E <br />50 <br />X <br />50 <br />B <br />0.3 <br />T <br />0.3 <br />E <br />� <br />X <br />1.0 <br />N/A 3 <br />Sample Results for TPH: <br />Maximum <br />Gasoline <br />1,000 <br />100 <br />10 <br />Non -Detected <br />Allowable TPH <br />Levels m <br />Diesel <br />10,000 <br />1,000 <br />100 <br />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). <br />� 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. <br />3 Levels for BTEX are not applicable at a concentration of 10 ppm for TPH—Gasoline or 100 ppm for TPH-Diesel. <br />VI. STAFF RECOMMENDATIONI REFERRALI REVIEW <br />1. Are BTEX or TPH Concentrations > Allowable Levels? 1 Yes�No <br />2. If No, Is Site Closure Recommended?',Yes ❑ No <br />Completed By: Vicky Vang-Lee <br />Date Referred to Site Mitigation Unit for Final Actions <br />Reviewed �- <br />Concur with Staff Recommendation�Yes ❑ No <br />Date Closure Letter <br />1All Cases are Referred to Site Mitigation for Final Action <br />EH 23-0080 (Rev 11/14/08) <br />