Laserfiche WebLink
CENTRAL 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 documentation of release and <br /> subsequent closure action. All files and reports will be placed on microfiche for review. <br /> I. Case Information <br /> LUSTIS Case no. URF filing date Closure date <br /> Site name/county <br /> Site address CityZip Phone <br /> Table I - Responsible Party Information <br /> Responsible party Name Address, City, Zip Phone <br /> Property owner <br /> Operator 1 <br /> Operator 2 <br /> Operator 3 <br /> II. Release and Site Characterization Information <br /> Tank size(s) Fuel type(s) <br /> Chemical type(s) and quantity(ies) released <br /> Table H - Lateral and Vertical Extent of Contamination <br /> Environment Lateral (ft) Vertical (ft) Contaminant Concentration Range <br /> Soil <br /> mg/kg <br /> Groundwater mg/l <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 /> 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 /> Surface water impacted? Yes No <br /> Name of surface water body affected <br />