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Tri Regional Recommendation Page 24 of 24 Appendix A TABLE 1 - CHECKLIST OF REQUIRED DATA FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES Site Name and Location ❑ i Distance to production wells for municipal, domestic, agriculture, industry and other uses within 2000 feet of the site, 2 Site maps, to scale, of area impacted showing locations of any former and existing tank systems, excavation contours and sample locations, boring and monitonng well elevation contours, gradients, and nearby surface waters, buildings, streets, and subsurface utilities, ❑ 3 Figures depicting lithology(cross section), treatment system diagrams, ❑ 4 Stockpiled soil remaining on-site or off-site disposal(quantity), ❑ 5 Monitoring wells remaining on-site, fate, ❑ 6 Tabulated results of all groundwater elevations and depths to water, ❑ 7 Tabulated results of all sampling and analyses ❑Detection limits for confirmation sampling ❑Lead analyses ❑ 8 Concentration contours of contaminants found and those remaining in soil and groundwater, and both on-site and off-site 0 ❑Lateral and ❑Vertical extent of soil contamination ❑Lateral and ❑Vertical extent of groundwater contamination ❑ 9 Zone of influence calculated and assumptions used for subsurface remediation system and the zone of capture attained for the soil and groundwater remediation system, ❑ 10 Reports/information ❑ Unauthonzed Release Form ❑ QMRs(Dates) ❑ Well and boring logs ❑ PAR ❑FRP ❑ Other(report name) 11 Best Available Technology(BAT) used or an explanation for not using BAT, ❑ 12 Reasons why background warms unattainable using BAT, ❑ 13 Mass balance calculation of substance treated versus that remaining, ❑ 14 Assumptions,parameters, calculations and model used in risk assessments, and fate and transport modeling, ❑ 15 Rationale why conditions remaining at site will not adversely impact water quality, health, or other beneficial uses, and ❑ 16 WET or TCLP results y Comments Date