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CENTRAL VALLEY REGIONAL WATER QUALITY CONTROL BOARD <br /> CASE CLOSURE CHECKLIST <br /> Leaking Underground Storage Tank Program <br /> *This checklist CASE CLOSURE letter. and the Unauthorized Release Report Form (URF) is to be <br /> retained by the Regional Board and Local Implementing Agency as documentation of release and <br /> subsequent closure action All files and reports will be placed on microfiche for review <br /> I. Case Information <br /> LU STIS Case no URF filing date Closure date <br /> Site name/county 7-1 10,22 <br /> Site address ''IX k:ti City .u" Zip Phone <br />' Table I - Responsible Party Information <br /> Responsible parry I Name I Address Citv, Zip Phone <br /> Propene owner <br /> Operator 1 IBX :i! U�f� rG �� �(�'�L 'Nt�1r, C/3 `*5 Z# <br />' Ooerator ? } <br /> Operator 3 <br /> II. Release and Site Characterization Informanon <br />,Tank size(s) ;�u�l T' Fuel type(s) <br /> 1 <br /> Chemical type(s) and quantity(les) released Lf--iwi <br />' J <br /> Table II - Lateral and Vertical Extent of Contamination <br />' F[Evironment Lateral (ft) Vertical (ft) Contaminant Concentration Range <br /> Soil b �, ] C. I �, ��� �;lJ G�ir� Z• ZLtCmg/kg <br /> Mg/l <br />' Groundwater rytl�r. <br /> ' Soil type at the site �1^� <br /> Source of drinking water under SWRCB POLICY 88-63 <br /> ' Were nearby wells (Domestic Municipal Ag, etc ) monitored? Yes No L <br /> Wells affected (Domestic Municipal. Ag, etc ) '24- <br /> Highest and lowest deDdis to groundwater i �C- <br /> Seasonal groundwater aradient(s) and directions) i ,t I <br /> ter a <br /> ' <br /> ' Name of Regional Nater Quality Control Plan (Basin Plan) aq affected (see attached) Y v� <br /> "-�'i�J� �'✓✓lam C,vv''GLF��. `.'�?�-1 <br /> Sur-race water impactea) Yes J No <br /> ;Name of surface water body affected <br /> � � <br />