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4 <br /> 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 /> to be retained by the Regional Board and Local Implementing Agency as documentation of <br /> release and subsequent closure action. AN flies and reports will be placed on microfiche for <br /> review. <br /> I. Case Information <br /> LUSTIS Case no. URF tiling date Closure date <br /> Site namelcounty mev,"t WA"LI#4, S^-N To a QU4+ <br /> Site address 7?? 7 W i 0t .17CItyZt-#LW Zip g s3 71; Phone a2d 9 <br /> TabN i•A pr+.n►Ia �oN <br /> R.ep,-61 PWr lNw. Ad*"*.crr.27' Pho <br /> owm 1 wt� ss f3lwl. I�kw �. �Qss <br /> opmw I J} c <br /> Opeals ►2 <br /> ov«.N.3 <br /> il. Release and Site Characterization Information <br /> Tank sizes) STT .1 a 144 Fuer type(s) CA-v o <br /> Chemical type(s) and quantity(iss) released TPn"-� 03T�X <br /> EnritonnMt u m(M YMNN 0 Cenlwwant C-w-ft"Wo RM4� <br /> soy F' ' <br /> Gna+Msur •�.� ' �+' � 7pN�. �y%iriy <br /> '10, awn <br /> Soil type at the site S, t <br /> Source of drinking water under SWRCS POLICY 88-63 JVD► <br /> Were nearby wells (Domestic, Municipal, Ag. etc.) monitored? Yes No X <br /> Wells affected (Domestic, Municipal, Ag, etc.) wanA fLxg&4A7- — <br /> Highest and lowest depths to groundwaW — 7 <br /> Seasonal groundwater gradlent(s) and directionjo vv <br /> Name of Regional Water Quality Control Plan (Basin Pian) a 'for armed (see attached) <br /> Surface water impacted? Yes No <br /> • Name of surface water body affected JY <br />