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APPEND B OF THE TRI -REGIONAL RECOb elENDATIONS <br />' CHECKLIST OF REQUIRED DATA FOR CLOSURE OF UNDERGROUND TANK SITES <br />cox46,4r4 ?,W e" <br />CLOSURE DOCUMENT APPLICATION SITE; 42,0 SW )Lt AN <br />1. � Distance to production wells for municipal, domestic, agriculture, industry and other uses within <br />2000 feet of the site; tp 3/f 3 t.l•SGsfi Sr', E0`1 -r <br />2. 0 0 Site maps, to scale, of area impacted showing locations of former and existing tank systems, <br />excavation contours and sample locations, boring and monitoring well elevation contours, <br />gradients, and nearby surface waters, buildings, streets, and subsurface utilities; p>kz& 3Yq 3 <br />3. Figures depicting lithology (cross section), treatment system diagrams; <br />4. Stockpiled soil remaining on-site or off-site disposal (quantity); I LI 00 Y � � Lp&{ 6 rtu�_ <br />5. Monitoring wells remaining on-site, fate; <br />6. -4r,,S Tabulated data of all ground water elevations and depths to water; <br />7.U&5 Tabulated results of all sampling and analyses: <br />Detection limits for confirmation sampling <br />Lead analyses <br />8. . Concentration contours of contaminants found and those remaining in soil and ground water, both <br />on- and off-site: <br />t,5 Lateral extent of soil contamination <br />a Vertical extent of soil contamination <br />Lateral extent of ground water contamination <br />Vertical extent of ground water contamination <br />9. * Zane of influence calculated and assumptions used for the subsurface remediation system and the <br />zone of capture attained for the soil and ground water remediation system; <br />10. 065 Reports/information rvk.' 55,,� �e[ &i — (� 1.5 re.S <br />�Unauthorized Release Form (URF) <br />q e QMRs (Dates) '61.3 5A Y17, 1 11 !` t 2 <br />PAR f y 3 <br />NFRP <br />IOther (report name)p, <br />Well and boring logs -7 y e. _-_, — p _ ,� ass , y t bar, , <br />\0, No 'fit 9 ('S <br />Best Available Technology (BAT) used or an explanation for not using BAT; <br />cv���` v►-. wv..L� �u; ��-c <br />12. jft.�__ Reasons why "background" was/is unattainable using BAT; <br />13. Mass balance calculation of the substance treated versus that remaining; <br />14. S Assumptions, parameters, calculations and model used in risk assessments, and fate and transport <br />modeling; <br />15. ( f,5 Rationale why conditions remaining at the site will not adversely impact water quality, health, or <br />other beneficial uses; and <br />16. --No WET or TCLP results <br />Comments: <br />By: 5 <br />Date: (o <br />