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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 <br /> entation of <br /> to be retained by the Regional Board and Local implementingdwill be pla ed on microf the for <br /> release and subsequent closure action All files anreports <br /> review <br />' i. Case information <br /> LUSTIS Case no URF filing date Closure date <br />' Site name/county Zip phone <br /> Site address City . <br />' Table I -Responsible Party Information <br /> Responsible party Asame <br /> Address City,Zip <br /> Phone <br />' Property owner <br /> Operator 1 <br />' operator 2 <br /> Operator 3 <br /> Il. Release and Site Characterization Information <br /> Tank size(s) Fuel types <br /> ' Chemical type(s) and quantity(ies) released <br /> Table lI-lateral and Vertical Extent of Contamination <br /> ' <br /> Environment Lateral(ft) Vertical(ft) Contaminant Concentration Range <br /> mglkg <br /> Soil <br /> ' mgli <br /> Groundwater <br /> ' Soil type at the site <br /> Source of drinking water under SWRCB POLICY 88-63 No <br /> Were nearby wells (Domestic, Municipal, Ag, etc ) monitored? Yes <br /> ' Wells affected (Domestic, Municipal, Ag, etc <br /> ' Highest and lowest depths to groundwater <br /> Seasonal groundwater gradient(s) and direction s <br /> Name of Regional Water Quality Control Plan (Basin Plan) aquifer affected (see attached) <br /> Surface water impacted? Yes No <br /> Name of surface water body affected <br />