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TABLE I - CHECKLIST OF REQUIRE=D DATA <br /> ' FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> Site Name and Location: 6 14 7 i�f, rt, ,Ic rc �;v''; C�,-lckmy <br /> 1. Distance to production wells for municipal, domestic, agriculture, industry and other uses within 2000 <br /> feet of the site; <br /> 2. ✓ Site maps, to scale, of area impacted showing locations of former and existing tank systems, <br /> excavation contours and sample locations, boring and monitoring well elevation contours, gradients, <br /> and nearby surface waters, buildings, streets, and subsurface utilities; <br /> ' 3. Figures depicting Iithology (cross section), treatment system diagrams; Soy } rrg lis <br /> 4. Stockpiled soil remaining on-site or off-site disposal (quantity); gTok 4.'J&5 'j,J I)tUY•S <br /> ' 5. Monitoring wells remaining on-site, fate; ryI W,, d;s}my <br /> 5. Tabulated results of all groundwater elevations and depths to water, <br /> ' 7. _Z Tabulated results of all sampling and analyses: <br /> ,Detection limits for confirmation sampling <br /> �t-ead analyses <br /> tS. Concentration contours of contaminants found and those remaining in soil and groundwater, both on- <br /> site and off-site: seyty , wtke- eoo►UmAA <br /> ' ateral extent of soil contamination�ertical extent of soil contamination <br /> Lateral extent of groundwater contamination <br /> �i Vertical extent of groundwater contamination <br /> 9. /V4 one of influence calculated and assumptions used for subsurface remediation system and the zone <br /> of capture attained for the soil and groundwater remediation system; <br /> ' 10. , Reports /information <br /> —: �tJnauthorized Release Form (URF) <br /> QMRs (Dates) /1zg <br /> _ PAR <br /> FRP <br /> Other (report name) u1'f4.c I'AA Lies <br /> ' Gvo�lcpl , Zj161gs" <br /> ' ✓ Well and boring logs c-t-os v /% ROq <br /> 11. Best Available Technology (BAT) used or an explanation for not using BAT; uw�um\ A*MU Zwn <br /> ' 12. Reasons why `=background"was/is unattainable using BAT; <br /> 13. -IC Mass balance calculation of substance treated versus that remaining; <br /> ' 14. _/ Assumptions, parameters, calculations and model used in risk assessments, and fate and transport <br /> modeling; <br /> 15. V Rationale why conditions remaining at site will not adversely impact water quality, health, or other <br /> ' beneficial uses; and <br /> 15. L¢ WET or TCE_P results <br /> ' <br /> Comments: <br /> By: <br /> Date: 1 2 2 DT <br /> I <br />