Laserfiche WebLink
i <br /> 1-11 Rc_tonal IZcrnIII III ench)tit:uI Pa, e ?a of 21a <br /> \ppcndix A <br /> TABLE 1 - CHECKLIST OF REQUIRED DATA <br /> FOR NO FURTHER ACTION REQUESTS AT UNDERGROUND TANK SITES <br /> Site Name and Location: <br /> I <br /> 1. Distance to production hells for municipal; domestic; agriculture. industry and <br /> other uses within 2000 feet of the site: <br /> 2 Site maps. to scale o1 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. <br /> ❑ 3. Figures depicting lithology(cross section):, treatment system diagrams. <br /> ❑ 4. Stockpiled soil remaining on-rile or off-site,disposal(quantity). <br /> ❑ 5 Monitoring wells remaining on-site, fate, <br /> i <br /> (❑ 6 Tabulated results of all groundva,ater elevations and depths to.water; - <br /> J 7 Tabulated results of all sampling and analyses: li <br /> ❑Detection lnnits for confirmalion 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. <br /> ❑Lateral and Vertical extent of soil contamination <br /> Lateral and ❑'Vertical extent of groundwater contamination <br /> ❑ ❑ <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 /> groundtwater rernediation system: <br /> ❑ 10.Reports/informationF1Unauthorized Release Form ❑ OMRs(Dates) <br /> Well and boring logs ❑ PAR ❑FRP ❑ Other(report name) _ <br /> ❑ 11.Best Available Technology(BAT) used or an explanation for not using BAT. <br /> 12.Reasons tachy background was/is unattainable using BAT: <br /> ❑ 13.Mass balance calculation of substance treated versus that remaining, <br /> t <br /> ❑ 14. Assumptions pat ameters. calculations and model used in risk <br /> assessments. and fate and transport modeling. <br /> 15. Rationale why conditions remaining at site will not adversely, <br /> quality.impact avater' ualil . health. or other beneficial uses: and <br /> I <br /> ❑ 16. WET or TCLP results <br /> • I <br /> By; Comments, <br /> Date: <br /> I <br />