Laserfiche WebLink
r <br /> CENTRAL VALLEY REGIONAL WATER QUALITY CONTROL BOARD <br /> CASE CLOSURE CHECKLIST <br /> -Leaking Underground Storage-Tank Prograni <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 /> LUSTIS Case no -34oyURF filing date rc;��// i5' - Closure date / <br /> Site name/County i.•-12�_ c//Dit -5a ie�rc <' -7 <br /> Site address �fs— �� �u J <br /> c%!� City_ s�,��� Zip Phone _ ,d� <br /> Table f - Responsible Party Information <br /> Responsible parry ►Warne Address, Ciry Zip 777_ 'Phone <br /> --Property owner <br /> Operator 1 <br /> Operator 2 ( ) <br /> Operator 3 { } <br /> II. Release and Site Characterization Information <br /> Tank size(s) „1!„a�. zip �a���/17_ ,< ,�f Fuel type(s) <br /> Chemical type(s) and quannty(ies) released z2,,z--gza<- 4./r� <br /> Table II - Lateral and Vertical Extent of ContanunAltion <br /> Environment Lateral (ft) Vertical (ft) Contaminant Concentration Range <br /> STT�;a d Off— 6006>Soil &.1Z,9.4 00-1 - 6o <br /> mgft <br /> Groundwater 3-4) n/1,q <br /> Soil type at the site . /a lam., Q yA( <br /> Source of drinking water under SWRCB POLICY 88-63 <br /> Were nearby wells (Domestic, Municipal, Ag, etc ) monitored? Yes No <br /> Wells affeeted (Domestic, Municipal, Ag, etc ) AIA _ <br /> Highest and lowest depths to groundwater �dC4�3 60z 7/ 1 <br /> Seasonal groundwater gradient(s) and direction(s) AA5- [a��r�,.�- �� a oar. <br /> Name of Regional Water Quality Control Plan (Basin Plan) aquifer affected (see attached) <br /> Sze\ Z-0a.atNl1 Co <br /> Surface water impacted? Yes No �4 _ <br /> Name of surface water bodv affected —yl -�-- <br />