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Tri Regional Recommendation Page 24 of 24 <br /> Appendix A <br /> TABLE 1 - CHECKLIST OF REQUIRED DATA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> Site Name and Location: Ae-C,a 5i-a 4 z; 45a I I LP!7 VJ<S4 St-r��r Sfi-p ck4vr\,Cls <br /> ' Er 1. Distance to production wells for municipal, domestic, agriculture, industry and <br /> other uses within 2000 feet of the site; PA 9 E 4 ;9 u v--r- I <br /> 0 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; �� 6 Gzv�at Z <br /> ' 3. Figures depicting lithology(cross section), treatment system diagrams; <br /> Aathrr.e4,i A ) Pagc I <br /> 0 4. Stockpiled soil remaining on-site or off-site disposal(quantify); <br /> Er5. Monitoring wells remaining on-site, fate; <br /> Paj,cz I -- 3 <br /> 6. Tabulated results of a#groundwater elevations and depths to water, ^T 6L 1, C 3 <br /> 7. Tabulated results of all sampling and analyses: -j`&6 t"53 I a,,,� -2 A-4Q C' eve ellc+ QAjOt G <br /> ❑Detection limits for confirmation sampling <br /> ❑Lead analyses <br /> 8. Concentration contours of contaminants found and those remaining in soil <br /> and groundwater,and both on-site and off-site: A-H <br /> ❑Lateral and ❑Vertical extent of soil contamination <br /> ❑Lateral and ❑Vertical extent of groundwater contamination <br /> i <br /> ' [�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; fJ t F} <br /> 10.Reports/information ❑ Unauthorized Release Form ❑ QMRs(Dates) <br /> Aagz, 1 - 3 <br /> '❑ l/ell and borin�los El PAR ❑FRP ❑ Other(report name) <br /> ' +a ac hr)newt <br /> 11.Best Available Technology(BAT)used or an explanation for not using BAT,' <br /> Ea12.Reasons why background wasrs unattainable using BAT' <br /> J <br /> 13.Mass balance calculation of substance treated versus that remaining, <br /> A-t4 a ci'n'&."_i -b <br /> 0 14. Assumptions,parameters, calculations and model used in risk <br /> ' assessments, and fate and transport modeling; +I f ci c k,0 r- <br /> 15. Rationale why conditions remaining at site will not adversely <br /> impact water quality, health, or other beneficial uses,and "C.Ck r""_"J 'C pct c 14 <br /> 0 16. WET or TCLP results N A <br /> y.' Comments: <br /> i ,Date: <br />