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CEINTRA.L VALLEY REGIONAL WATER QUALITY CON'T'ROL BOARD <br /> CASE CLOSURE CHECKLIST <br /> Leaking Underground Storage Tank Program <br />' �us 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 ides and reports will be placed on microfiche for review <br />' I. Case Information <br /> LUSTIS Case no URF filing date Closure date <br />' Site namelcountr cq 'v�.^ <br /> Site address CuyS}oc Nl .n _ Zip Phone NItA <br />' Table F - Responsible Party Information <br />' Responsible pang Name Address. City, Zip Phone <br /> Property owner 1A L A\\\-%kr 1 r.)S 5 r t �, (i JS } 38b - 13 C 3 <br />' Operator I ( } <br /> Operator 2 ( } <br />' Operator 3 ( } <br /> tRelease and Site Characterization Information <br /> nsize(s) (a - d v o 1\���s e b,tae th\-s Fuel types) <br />' Chemical type(s) and quantity(ies) released F1 d , $ i vr�:{a(s ,�.�� � e+•t�,,,.-, <br /> Table II -Lateral and Vertical Extent of Contamination <br /> Environment I Latera! (ft) Vertical (ft) Contaminant Concentration Range <br />' Soil C5x Sa !`� T�t� � x UD - Li 20 mSfkg <br /> Groundwater -104 ('o ) ,, mgfl <br />' <br /> Soil a at the site L a,n Ee �A cla wl+'� Q,4ci avvi s.If sv <br /> type � � a-� Lh n C..r f'ks <br /> Source of drinking water under SV RCB POLICY $&63 <br /> Were nearby wells (Domestic, Municipal, Ag, etc.) monitored? Yes No <br /> Wells affected (Domestic, Municipal, Ag, etc.) NoV\ V_v\c.� <br /> Highest and lowest depths to groundwater �5 c 9 - Irk . IL4 <br /> Seasonal groundwater gradnent(s) and direction(s) <br /> e of Regional Water Quality Control Plan (B an Plan) aquifer affected (see attached) <br /> Surface water impacted? Yes No <br /> Nape of surface water body <br />