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Tri Regional Recommendation Page 24 of 24 <br />Appendix A <br />r <br />- TABLE 1 - CHECKLIST OF REQUIRED DATA <br />..� FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br />Site Name and Location: <br />1. Distance to production wells for municipal, domestic, agriculture, industry and <br />other uses within 2000 feet of the site; <br />❑ 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 />❑ 3. Figures depicting fithology (cross section), treatment system diagrams; <br />E14. Stockpiled soil remaining on-site or off-site disposal (quantity); <br />❑ 5. Monitoring wells remaining on-site, fate,- <br />0 <br />ate; <br />0 6. 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 />11 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 />❑ Lateral and ❑ Vertical extent of soil contamination <br />F1 Lateral and ❑ Vertical extent of groundwater contamination <br />ED 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 remediation system, <br />r <br />❑ 10. Reports /information ❑ Unauthorized Release Form QMRs (Dates) <br />❑ Well and boring logs ❑ PAR ❑ FRP .❑ Other (report name) <br />r ❑ 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 />❑ 14. Assumptions, parameters, calculations and model used in risk <br />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 />E116. WET or TCLP results <br />f 1 By: Comments: <br />Date: <br />r. <br />