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TABt r I - CHECKLIST OF REQUIRED D-—A <br /> FOR NO FURTHERNg-r;TION REQUESTS AT UNDERGRtY6ND TANK SITES <br /> Site Name and Location: 4 <br /> 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 lithology (cross section), treatment system diagrams; <br /> 4. _6L` Stockpiled soil remaining on-site or off-site disposal (quantity); <br /> 5. _✓ Monitoring wells remaining on-site, fate; - <br /> 6. -"/Ta bu late d <br /> /Tabulated results of all groundwater elevations and depths to water; <br /> 7. / Tabulated results of all sampling and analyses: <br /> Detection limits for confirmation sampling <br /> Lead analyses <br /> S. �� Concentration contours of contaminants found and those remaining in soil and groundwater, both on- <br /> site and off-site: <br /> Lateral extent of soil contamination <br /> Vertical extent of soil contamination <br /> Lateral extent of groundwater contamination <br /> Vertical extent of groundwater contamination <br /> Zone 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 /> Unauthorized Release Form (URF) <br /> QMRs (Dates) <br /> _ PAR <br /> _ FRP <br /> Other (report name) <br /> Well and boring logs <br /> 11. ✓ Best Available Technology (BAT) used or an,explanation for not using BAT; <br /> 12.0 P� Reasons why"background"was/is unattainable using BAT; <br /> 13. // Mass balance calculation of substance treated versus that remaining; <br /> 14. J Assumptions, parameters, calculations and model used in risk assessments, and fate and transport <br /> modeling; <br /> 15. Rationale why conditions remaining at site will not adversely impact water quality, health, or other <br /> beneficial uses; and <br /> 16.�E WET or TCLP results <br /> Comments: <br /> Rib <br /> By: <br /> i <br /> 1 Date: <br />