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f <br /> Tri Regional Recommendation Page 24 of 24 <br /> Appendix A <br /> TABLE 1 - CHECKLIST OF REQUIRED DATA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> Site Name and Location AVCo G+e-- +p,-N -iL OnSO, 4>S ��S I t �-� �� Ar•e�'>�s c , La`i-�+� °f <br /> 1 Distance to production wells for municipal, domestic, agriculture, industry and <br /> other uses within 2000 feet of the site, Le{-},:!r�y P6ze,),- 3 <br /> F12 Site maps, to scale, of area impacted showing locations of any former and existing tank systems, <br /> excavation contours and sample locations, boring and monitoring well elevation contours, 4- <br /> gradients, and nearby surface waters, buildings, streets and subsurface utilities, A-f4 UC <br /> �3 Figures depicting lithology(cross section), treatment system diagrams, <br /> A rf ckc E,vv,-e---i 'D <br /> E 4 Stockpiled soil remaining on-site or off-site disposal(quantity), L_a f_-« PC'Je { <br /> El5 Monitoring wells remaining on-site, fate, ;�Cj U r--f- -2- <br /> F771 6 Tabulated results of all groundwater elevations and depths to water, —1 h tom$ 1- 3 <br /> i <br /> 7 Tabulated results of all sampling and analyses <br /> ❑Detection limits for confirmation sampling A-}+G,o' f$ f5 ¢C <br /> ❑Lead analyses <br /> 8 Concentration contours of contaminants found and those remaining in soil <br /> and groundwater, and both on-site and off-site -r{ �G� y ��4-- C <br /> ❑Lateral and ❑Vertical extent of soil contamination <br /> t ❑Lateral and ❑Vertical extent of groundwater contamination <br /> Q9 Zone of influence calculated and assumptions used for subsurface <br /> remediation system and the zone of capture attained for the soil and <br /> groundwater remediation system, \/ / A <br /> ❑ 10 Reports/information Unauthorized Release Form ❑ QMRs(Dates) <br /> Well and borrn los ❑ PAR ❑FRP ❑ Other(report name) <br /> ❑ 11 Best Available Technology(BAT)used or an explanation for not using BAT, <br /> L etf7�v• PF y eg �— <br /> ❑ 12 Reasons why background was/is unattainable using BAT, >/A <br /> 13 Mass balance calculation of substance treated versus that remaining,-i✓I A - <br /> 14 Assumptions,parameters, calculations and model used in risk <br /> assessments, and fate and transport modeling, W 1A <br /> 0 15 Rationale why conditions remaining at site will not adversely <br /> impact water quality, health, or other beneficial uses, and <br /> ❑ 16 WET or TCLP results /pl <br /> By Comments <br /> Date <br />