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Tri Regional Recommendation <br /> Page 24 of 24 <br /> Appendix A <br /> TABLE 1 —CHECKLIST OF REQUIRED DATA <br /> i <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES f <br /> Site Name and Location: <br /> 1. Distance to production wells for municipal, domestic, agriculture, industry and <br /> other uses within 2000 feet of the site; <br /> Site maps, to scale, of area impacted showing locations of any former and existing tank systems, s <br /> excavation contours and sample locations, boring and monitoring well elevation contours, <br /> gradients, and nearby surface waters, buildings, streets, and subsurface utilities; <br /> [V3. Figures depicting lithology(cross section), treatment system diagrams; . SCAM 0br <br /> ova on <br /> &14. Stockpiled soil remaining on-site or off-site disposal(quantity); 1AWN C <br /> IV5. Monitoring wells remaining on-site, fate; <br /> ;ePra Tabulated results of all groundwater elevations and depths to water; s�j s4mor jesfwwoo ' <br /> T Tabulated results of all sampling and analyses: <br /> �etection limits for confirmation sampling <br /> ❑Lead analyses14� * *Oct, C� ",N)�& <br /> ❑ a. Concentration contours of contaminants found and those remaining in soil I <br /> and groundwater, and both on-site and off-site: SIM <br /> r <br /> 1 ateral and ' ertical extent of soil contamination 0�� �� �O j <br /> teral and ., al extent of groundwater contamination <br /> ❑ 9. Zone of influence calculated and assumptions used for subsurface <br /> remediation system and the zone of cap re attained for the soil an���������� ! <br /> --groundwater remediation system; I <br /> NA 10.Reports/information ❑ Unauth rize Release�rm QMRs(Dates) <br /> 0 Well and boring logs ❑ PAR ❑FRP ❑ Other(report name) <br /> 5RO11.Best Available Technology(BAT)used or an explanation for not using BAT <br /> ALA <br /> 12.Reasons why background was/is unattainable sing BAT,' N <br /> 13.Mass balance calculation of substance treated versus that remaining, <br /> 14 GRt�+wV JA; OCOI t l G�t.t nN IIJ Worse : <br /> 14. Assu ptions,parameters, calculations and model used in risk � � <br /> `assessments, and fate and transport modeling; <br /> . P&.A <br /> nr 5. Rationale why conditions remaining at site will not adversely 1 ON�� N <br /> u impact water quality, health, or other beneficial uses;and � wi a * MOO <br /> I <br /> ❑ 16. WET or TCLP results <br /> APAwAhuL <br /> By Comments: <br /> Date: <br /> a <br />