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�.-.� <br /> ._ CENTRAL VALLIfiREGIONAL WATER QUALI`l; CONTROL BOARD <br /> s CASE CLOSURE CHECKLIST <br /> Leaking,Underground Storage Tank Program <br /> This checklist, CASE CLOSURE Ietter, and the Unauthorized Release Report Form (URF) is to be <br /> retained by the Regional Board and Local Implementing Agencv as documentation of release and <br /> subsequent closure action. All files and reports will-be placed on microfiche for review. <br /> I. Case Information a <br /> LUSTIS Case no. URF filing date . Closure date <br /> Site name/county <br /> Site address City Zip Phone <br /> Table I - Responsibl,e Party,Information,. <br /> � �. _. _ <br /> _____j <br /> Responsible party Name Address, City, Zip Phone <br /> Property owner <br /> Operator 1 <br /> Opermor.2 <br /> l <br /> Operator 3 <br /> f <br /> I <br /> II. Release and Site Characterization Information <br /> Tank size(s) Fuel type(s) 4= <br /> Chemical type(s) and quantity(ies) released <br /> Table II - Lateral and Vertical Extent of Contamination <br /> Environment Lateral (ft) Vertical (ft) Contaminant Concentration Range i <br /> Soil <br /> Groundwater. � <br /> Soil type at the site <br /> Source of drinking water under SWRCB POLICY 88-63 <br /> Were nearby wells (Domestic. Municipal, Ag, etc.) monitored? Yes No <br /> Wells affected (Domestic, Municipal, Ag, etc.) <br /> r <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 /> S <br /> Surface water impacted? Yes No <br /> Name of surface water body affected <br /> a <br />