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TABLE 1 - CHECKLIST OF REQUIRED DATA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> Site Name and Location: <br /> NA 1. Distance to production wel for municipal, domestic, agriculture, industry <br /> and other uses within 2000 feet of the site; <br /> �► 2. Site maps to scale taf a►P�tPrl Showing locations Qforrper�tank systems, <br /> excavation contours and sample locations, <br /> Wradier�and n wa <br /> Q�® 3.Figures depicting litholo y(cross section), treatment system diagrams, <br /> 4. Stockpiled soil remaining on-site or off-site disposal(quantity), <br /> 57 <br /> NA 5. MonittSrin9 wells remaining on-site, fate; <br /> 6nTabulat d result`s of all rou�w ter ele tions a d de ��tol�er; - ��� �/G'��s�`� <br /> �` 7.Tabulated resa(ts 11 samplin and anal e : I viv a <br /> V Detection limits for confirmation sampling <br /> z/�y� T� � <br /> Lead analyses U � 2 O <br /> it d5 T— 6DQ <br /> T� y <br /> 8. Concentration contours of contaminants found and those remaining in so 7, <br /> ,J <br /> and groundwater, a d both on-site and off-site: <br /> Lateral and� `r� Vertical extent of soil contamination�--2 s K0 <br /> Vertical extent of groundwater contamination <br /> N Lateral and 9 <br /> NA 1 9.Zone of influence calculated and assumptions used for subsurface <br /> remediation system and the zone of capture attained for the soil and �Q , / <br /> groundwater remediation system; ' v' <br /> 10.Reports/information Unauthorized Release off QMRs(Dates) 3• � ` � . <br /> Welland boring logs ❑N PAR FRP ®Other(report name)C&14 , �J <br /> Otl 11.Best Available Technology(BAT) used or an explanation for not using BAT,' ��n�y P�✓��� �� <br /> 1pliii 12.Reasons why background warms unattainable using BAT; <br /> 13.Mass balance tiopoo sub tance treated versus that remaining; — <br /> Q.0oi 3 /� <br /> NA 14.Assumptions,parameters, calculations and model used in risk <br /> assessments, and fate and transport modeling; v ,( <br /> W= 67 <br /> 15.Rationale why conditions remaining at site will not adversely b �' <br /> VV impact water quality, health, or other beneficial uses;and <br /> NA 16.WET or TCLP results <br /> By; Comments: <br /> Date: i C�� <br />