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Tri Regional Recommendation Page 24 of 24 <br /> Appendix A <br /> TABLE 1 - CHECKLIST OFREQUIRED DATA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> Site Name and Location: <br /> ❑P, Distance to production wells for municipal, domestic, agriculture, industry and <br /> other uses within 2000 feet of the site; <br /> ❑12. Site maps, to scale, of area impacted showing locations of any form6 rand existing tank systems, <br /> excavation contours and sample locations, boring and monitoring well elevation contours, <br /> gradients, and nearby surface waters, buildings, streets, and subsudace utilities; <br /> ❑13. Figures depicting lithology(cross section), treatment system diagrams; <br /> ❑ Stockpiled soil remaining on-site or off-site disposal(quantity); <br /> ❑ 5. Monitoring wells remaining on-site, fate; <br /> E`6. Tabulated results of all groundwater elevations and depths to water j <br /> ❑ 7, Tabulated results of all sampling and analyses: <br /> ❑Detection limits for confirmation sampling <br /> r. <br /> �� ❑Lead analyses <br /> 4 <br /> ❑ 8. Concentration contours of contaminants found and those remaining in soil <br /> ii and groundwater, and both on-site and off--site: <br /> A ! ❑Lateral andElVertical extent of soil contamination <br /> Lateral and Vertical extent of groundwater contamination <br /> ❑ 9. Zone of influence calculated and assumptions used for subsurface <br /> remediation system and the zone of capture attained for the soil and <br /> i groundwater remediation system; <br /> ❑4 10.Reports/information ❑ Unauthorized Release Form ❑ Q Rs(Dates) <br /> J❑ Welland boring logs ❑ PAR ❑FRP ❑ Other(report name) <br /> ❑ 11.Best Available Technology(BAT) used or an explanation for not using BAT,- <br /> ❑.: 12.Reasons why background was/is unattainable using BAT, <br /> } <br /> ❑ 13.Mass balance calculation of substance treated versus that remainin ; <br /> ❑ 14. Assumptions, parameters, calculations and model used in risk <br /> assessments, and fate and transport modeling; <br /> ❑ 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 ` <br /> By. Comments: <br /> Date: <br /> E <br /> II <br />