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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 />' LUSTIS Case no URF filing date Closure date <br /> Site name/county FOR meA FA ti RI CARE FA CItiTY / SA" TOAQUIiJ cOur+TY <br />' Site address }[ S SAN J0A aV(•4 ST City_5 T 0 c_kr 0 N Zip Phone <br /> Table I - Responsible Party Information <br />' Responsible parry Name Address, Ciry. Zip Phone <br /> Nis MARIAN FRY 12 0 130)c ,S}0 ( 510 l$$6-5000 <br /> Property owner 1clo ANTHONY VAR41 HAYwARt) CA 94543 <br /> Operator 1 � � } <br /> Operator 2 <br /> Operator 3 <br /> U. Release and Site Characterization Information <br />' Tank size(s) 10 K I K K Fuel type(S) LEA 0 E Q G A s o L I N E ¢ D t E S E L <br /> Chemical type(s) and quanuty(ies) released L E A D E D G A S 0 L I N E Q VA r+T I TY u N K N 0 W N <br /> Table II - Lateral and Vertical Extent of Contamination <br /> Environment Lateral (ft) Vertical (ft) Contaminant Concentration Range <br /> Soil 10 7-9. 5 TPR - GASOL1NS 4 .4 mgllcg <br /> 0.110 TPHCr <br />' Groundwater 50 UNDEFINED YPH-GASOLINE, GrEX, LEAD 0 0OL STE)c mg/1 <br />' 1.0 <br /> Soil type at the site Ay, SILTY CLAY SILTS FINE - MEOtVM SANG) <br /> Source of drinking water under SWRCB POLICY 88.63 CITY OF s T O C k T 0 N <br /> Were nearby wells (Domestic, Municipal, Ag, etc.) monitored? Yes No X <br /> Wells affected (Domestic, Municipal, Ag, etc ) NA NEA RE ST w A T t R WELL Is <br /> APPROX ( MATELY [, 000 FEET NoATR OP SIrF- <br /> Highest and lowest depths to groundwater 31 IS -- 3-f 64 F E e T me-5 <br /> Seasonal groundwater gradient(s) and direction(s) E A S T E R LY Can a 0 0 x F T I F r. <br /> Name of Regional Water Quality Control Plan (Basin Plan) aquifer affected (see attached) <br /> SAN 30AaviN coVNTY <br /> Surface water impacted? Yes No x ? <br />' Name of surface water body affected NA <br />