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TAmPL.E 7 - CHECKLIST OF REQUIRED bj<TA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> s <br /> Site Name and Location: A _T RAWfe2 /Do S&-iw VE-4-t ta, S7ocK,o.i TA.4 - 0%"ma <br /> A I`s (Z1. L 04ues r-c Q r i O1S64-uo Tnuc_r C?,ut J <br /> 1. N Distance to production wells for municipal, domestic, agriculture, industry and other uses within 2000 feet <br /> of the site; , 2.00-Ot t, De er c4).4,+ <br /> 2. Site maps, to scale, of area impacted showing locations of former and existing tank systems, excavation <br /> contours and sample locations, boring and monitoring well elevation contours, gradients, and nearby <br /> surface waters, buildings, streets, and subsurface utilities; R""C"j"° <br /> 5Kaft-1 to -IS-8"7 <br /> 3. til Figures depicting lithology (cross section), treatment system diagrams; lolccaltYK 7 _ T _ 8,8 <br /> 4. y Stockpiled soil remaining on-site or off-site disposal (quantity); 3Cboy4 3 �S�byd'ccb�.. 0AsRF.- <br /> 5. Monitoring wells remaining on-site,fate; Pyxnorv. o "ZgSOrd' <br /> 6. Tabulated results of all groundwater elevations and depths to water, to-i o Dcs wu u <br /> 7. Tabulated results of all sampling and analyses: <br /> Detection limits for confirmation sampling <br /> t3- Lead analyses <br /> 8. Concentration contours of contaminants found and those remaining in soil and groundwater, both on-site <br /> and off-site: 130 ?PNS �, zl �►�ss <br /> _y Lateral extent of soil contamination <br /> Vertical extent of soil contamination ° 16�r3c1 <br /> Lateral extent of groundwater contamination y 14vnnpP4-N 12 DIFSEu 1 600-,51 r* 3c6d),4Xyla, <br /> N Vertical extent of groundwater contamination <br /> 9. Zone of influence calculated and assumptions used for subsurface remediation system and the zone of <br /> capture attained for the soil and groundwater remediation system; <br /> 10. Reports/information <br /> ,.Y Unauthorized Release Form (URF) FEa SY <br /> QMRs (Dates) <br /> _ PAR <br /> FRP <br /> Other(report name) Sr r- qj <br /> Well and boring logs 93 50o0APtz x 20,'t dC&P <br /> 11. Best Available Technology(BAT) used or an explanation for not using BAT; ApPRU?' 3 600yd:)o„tgExAv*-rt, <br /> 12. !J Reasons why'background"wasfis unattainable using BAT; CfO,00a O'Lj.. DC.,,A-r".0% �e <br /> 13. .PJ Mass balance calculation of substance treated versus that remaining; <br /> sRr nMe y ser„ pec 9S <br /> 14. r�A- 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. P3 WET or TCLP results <br /> Comments: ExcAvA->»r► Re,4"ev rjUyc or ca-r. QrAnrc9 satL Ce TN+awvr,oy Re►+Aiv1w�(, <br /> • 1AjDRc>NmcN " s FRO- TO-vK DfTr2c9 S20=)+--rP0d 54A/t ?(yrur 0.3m4)L $r-zr-c <br /> By: J r<13 <br /> Date: `! F1-b q`) <br />