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'0 TABLE 1 - CHECKLIST OF REQUIRED DATA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br />' <br /> Site Name and Location Chevron Service Station#9-2396,25651 Highway 99 North,Acampo,CA <br />' X 1 Distance to production wells for municipal, domestic, agriculture, industry and <br /> other uses within 2000 feet of the site, <br />' a 2 Site maps, to scale, of area impacted showing locations of any former and existing tank systems, <br /> excavation contours and sample locations, boring and monitoring well elevation contours, <br /> gradients, and nearby surface waters, buildings, streets, and subsurface utilities, <br /> M3 Figures depicting lithology(cross section), treatment system diagrams, <br /> MX 4 Stockpiled soil remaining on-site or off-site disposal(quantity), <br /> 0 5 Monitoring wells remaining on-site, fate, <br /> ® 6 Tabulated results of all groundwater elevations and depths to water, <br /> ® 7 Tabulated results of all sampling and analyses <br /> r 71 <br /> Detection limits for confirmation sampling <br /> Lead analyses <br /> ® 8 Concentration contours of contaminants found and those remaining in soil <br /> and groundwater, and both on-site and off-site <br /> 10 M11" <br /> ULJ Lateral and ❑X Vertical extent of soil contamination <br /> ^'" Lateral and N" Vertical extent of groundwater contamination <br /> NA 9 Zone of influence calculated and assumptions used for subsurface <br /> remediation system and the zone of capture attained for the soil and <br /> groundwater remedia tion system, <br />' ® 10 Reports/information ❑ Unauthorized Release Form ❑ QMRs(Dates) <br /> 0X Well and boring logs PAR ❑ FRP ❑ Other(report name) <br />' 0 11 Best Available Technology(BAT) used or an explanation for not using BAT, <br /> 12 Reasons why background was/is unattainable using BAT, <br />' ® 13 Mass balance calculation of substance treated versus that remaining, <br />' NA 14 Assumptions,parameters, calculations and model used in <br /> risk assessments, and fate and transport modeling, <br />' © 15 Rationale why conditions remaining at site will not adversely <br /> impact water quality, health, or other beneficial uses, and <br /> NA 16 WET or TCLP results <br />' By Stephanie Furgal Comments No groundwater impact <br /> Date 11-25-04 <br />