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4_. <br /> ur <br /> CEI'TTRAL 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 to be <br /> retained by the Regional Board and Local Implementing Agency as docu.Mentatlon of release and <br /> subsequent closure action All files and reports will be placed on microfiche for review <br /> I. Case Information <br /> LL STIS Case no URF riling date r�� i - Closure date <br /> Site name/county -/ s'- , <br /> Site address w, City o Zip Phone <br /> Table I - Responsible Party Information <br /> Resmnsible para Name kddrems, Gn% ZiD Phone <br /> -Prop-em owner <br /> Opt.-ator 1 I { <br /> oaerwor?JFI ( ) <br /> Operator 3 { ) <br /> II. Release and Site Characterization Information <br /> Tank size(s) rA.,e tea_e;n-o_a.1/1•,�, --z r Fuel types) <br /> Chemical types) and quantity(les) released <br /> Table II-Lateral and Vertical Extent of Contamination <br /> Environment Lateral (ft) Vertical (h) Cons-itmant ConCentrzuon Raage <br /> ons /6, o04,4>Soil Sb /.�,� �.�� -�$a,►�.� a 00.71- i6o i:ng1kg <br /> Groundwater SID n///� mgll <br /> Soil type at the site a lka e/ uP� <br /> Source of dnnktng water under S�4'RCB POLICY 8853 <br /> 'Were nearby wells (Domestic, Municipal, Ag, etc ) monitored Yes No <br /> "Wells affected (Domestic, Mumcipal, Ag, etc <br /> Highest and lowest depths to groundwater <br /> Seasonal groundwater gradient(s) and dirrction(s) _-� p <br /> ?Name of Regional Water Quality Control Plan (Basin Pian) aquifer affected (ser attacbed) <br /> Surface water -impacted? Yes No 7� <br /> Name of suer ace water body affected A)/,a <br />