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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 <br /> to be retained by the Regional Board and Local Implementing Agency as documentation of <br /> release and subsequent closure action All files and reports will be placed on microfiche for <br /> review <br /> I Case Information <br /> LUSTIS Case no 00 Y 5G 7 URF filing date 19-1 F- / Closure date <br /> Site name/county 47 y S %o H.f (?4,wv F P- t- 7-&,t}� gyp. S A N a A- Q <br /> Site address r F-7 7 s' %"'L Gig cIty—Ti-OLcy city—Ti—aZip 9s3�� Phone_.2 v 2 <br /> Table I-Responsible Party Informabon <br /> Rasponsibh party Flame Aderess <br /> City Zip Phone <br /> Property owner �ar✓T-R- C49f3ay 0-o5i 03�rbFrl <br /> Operator t �y q <br /> •lr Ft l ? <br /> Operator 2 <br /> i 7 <br /> Uperalor 3 <br /> f ) <br /> Il, Release and Site Characterization Information <br /> + Tank size(s) ssm (5:4L- Fuel type(s) Cr As o v15- <br /> Chemical <br /> 15Chemical type(s) and quantity(ies) released 7e hi-- C-- <br /> Table Ii-Lateral and Vertrcal Extent of Contamination <br /> [[E;nvInonmem lateral(n) Vertmai(ft) Contaminant <br /> /� Concentral"Range <br /> od Sa Fr G � F+ r JrounOwater ���'( � L,� rT (�. fro mgrkg <br /> ►�- n%X 3 1 0 mtyl <br /> Soil type at the site S; /t <br /> Source of drinking water under SWRCB POLICY 88-63 P 9 5 c A- V00- 4 b} , l'5 TV,i Li <br /> Were nearby welts (Domestic, Municipal, Ag, etc ) monitored? Yes No <br /> Wells affected (Domestic, Municipal, Ag, etc o t� <br /> Highest and lowest depths to groundwater S J D Far✓ <br /> Seasonal groundwater gradient(s) and directions S 4 o d:z <br /> Name of Regional Water Quality Control Plan (Basin Plan) aquifer affected (see attached) <br /> �. SAC az.A w21AU a... Set&, -TO U RA Ve v AS i ovs <br /> Surface water impacted? Yes No <br /> Name of surface water body affected <br />