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EMERGENCY Leak Moho Confirmed- leak suspected at site, but hes not been con`_:rec d.
<br /> indicate whetber emergency respous= pexs:;;rna1 and ep'Pment ware nnvohed- Crzliminas `lte wo an Submi ted - workplan/proposal
<br /> at any time. lY se, a Hiza lous tiat::ri=_1 :ncrient Report shocLd i,c• fried _aquastad=of/submit respoflsible party to determine whether grmvid
<br /> with the State Office of Emergency 3et+.ces (OES'( at 2800 Meadow^ ew Read. .,-iter haasbeen, or..V1I,t be, impacted as a result of the release.
<br /> Sacramento, CA .5832 Cunles of taw CES reperr" form may Le Oil ta.c:i at L.e7.iminat gat Ass mant Ain •w - implemontaEion'of workpl.en.
<br /> your Local ur.dergrourd storage Leak perrctting agency. .,dicate whether 'o Ll utiod�Chars taxi tri •'responsible party is in the process of L,.Liy
<br /> t,be GES raport, h,, beer Lied a= if ri.e aa-,e of 65's repot'., definin the extent m - camtemiestion in soil and
<br /> g ground water and as•-
<br /> :l t.s on sufaca�arWjor grauifd water.
<br /> LOCAL A i.NCY ONL=. F: r -atian Plan - rq td'_ation plan $Ubmitmed acaluating L ng ns
<br /> To avoid duplicate notification pursuant to flea Lth wd Safety code Sectioe. r r diatfor entieno. ' Proposal and ijtplamertntion schedule _.
<br /> 2'180.5, a gwernmeiit employee should sigp and dpts/the f44AApp in this:bloc4. rzre:iiation options Also submitted.
<br /> A signature here does not mean _ha'. the leak has. bean aeta=ned to pose A Cl amp Underway -.iAplementation ofjremediatrcn plan.
<br /> significant threat to human health at safety, only that ratification Post Clean. MOLL- h in Pro rasa : periodic ground water oe other
<br /> procedures -/tare been followed if required, .�on,torirg at site, necessary, toyverify and/or evaluate effectiveness
<br /> cf remedial activit}as.
<br /> w.EFOP.TEO BY '-_ 113se Closed - regional board and local agency in :oncurrence -,hat no
<br /> tar your name telephone n -Abe. end address. Ir.9icote�whieh part4s%uy _trther work is nece`esepr at the site.
<br /> ;resent and provide company or ig^ncY name.:
<br /> ^
<br /> A\ C`:TANT: THE].�IN�FORMATION PROVIDED ON THIS FORM IS INTENDED FOR GEFRAL
<br /> SPONSIBLE PARTY iSTI':Ai; PLTRL9ilas5 ONLY AN? TS NOT TO BE CON-TRUED AS REFRESENTINC
<br /> Enter name, telephone number, cor.tac, person. au.] address of Site "arty 7FF:_TAL POSITIIf6M OF ANY GOVERNMENTAL AGENCY
<br /> -
<br /> rasponsible for the Lean. Ti,e respensihie party would ncrs:a_iy be the tank
<br /> OWTAZ RUIF"SAL ACTION - -
<br /> n^route which atY.ion have teen used to cleanup cr reoedi ate the leak`.
<br /> SITE LOCATION De sriptionslof options follow:
<br /> Enter informaticr. regarding the tank facility. At a minimum, yon must ':�-
<br /> provide the faci Lity name and full address. t Cif Sr i - install horizontal impereab Le layez to•-Teauce rair�all
<br /> - infiltration.IMPL -7
<br /> Enter inamING AGENCIES Z:' Containment Barrier install vertical dilre twbloek Borizontah davemant of.
<br /> Ental names of the local ager...-/ And Reg-anal Wate_ Quality Cort_o1 2said- ` contaminant.- -
<br /> i:;volved. Excavate and-Dtsbose remove contaminated 'soil and dispose in approved
<br /> site
<br /> SUBSTANCES INVOLVED Ercavate end Treat - remove ccutimminat ed soil and treat,(include$-spreading,
<br /> Enter the name and quant it} lost of tls� hazag8gds iaubst a volved '- or land fa1'm'fng)
<br /> is provided for information u.: Laic u1}stap<ss £ eppr ata. If mo L, A Ramovo Free mduc4. ', recrove floating productrgm„water Lab L's.
<br /> two substances leaked, list the i. p�pw t ea jce>.M Pqr cleengp. P and.Treat oEnctwatex - generally 9*Loyed to te(Eov7 disatlwed -
<br /> 'rn 4. cohtaminadits. < I i - c - -
<br /> DISCOVERYlABATEMENT ,{' L ! is falx eed bio ee, ad .liou uSe of any available!;tschnolta, to Oro"Pcovide information regarding the.�isiovld afid adate�ent the Leen. baetetia'1'daEompositl� o: contaminants.
<br /> -.}•- F r P:place Supp1Y provrdr alternative water supply to affected ppafties
<br /> SOURCE/CAUSE T-eatr, L; a Hookup - install water treatment devices At each dualling or
<br /> `dicate source(s) of lee:.k. Checkkboi(ei) indieeting.'caus of.leak. '•f Other ,jIlMe•of ase. -;
<br /> ff + fJ \ V m E tact use pumps ar blewerA tq draw air thrpUg{i soil'.
<br /> 'l_A.a TYPE C V of - bore haes in soil to allow vo Latiliaation, of contaminants.
<br /> IT:dicate the case Lype,Q it far this ' qk. Check one box only. Cash No Action. a Vires�- 'incident is mjmor, regaiiripy no C'emadial Potion.
<br /> type is based on them$t s ive r souhfe affedi.ed. For example, if ,j ! .; 5 -
<br /> both soil. and ground wayax been affected, cafe type', will be "Ground' I COP41E\ - us
<br /> a tiffs Apacel to Ailabogate;bn any as
<br /> .,pacts. of the incident':
<br /> Watat". Indicate Drirdrin %If;ter" only if one or ire nine}gipal or ": '
<br /> domestic water wells *6va anally been affeoEW. i A '•GrouEO Water" SIGNAT - $ign'the for6 in the space provided;
<br /> design.ation does rot imply th tile' affected g*er cannot be, or is not,' !
<br /> . ed for drinking Nagar,' W- oply¢.cbhet water hells, have not yet. he=-n
<br /> affected It is udder
<br /> atocd-that Cass gypa,,may change upon further if the form IS :aneLeted by the tank owner or his egeiit penin the.last copy
<br /> investigatitln. 'ane forty11:I tQe remaining copies intact-to your 10081 to :r nesm'tting agency
<br /> N 5 ( r ��i 1. Otig 3L - LoaAl Tank Ye-mittidg A-gencv
<br /> In
<br /> at.
<br /> E A .ategary ich )544, e_csibes my r,rra Status o rase. BtaL w'at=- -
<br /> $1 t� ii -ou cos _rnrro B aid, Uivicion of Cleeq Water *dgrams
<br /> Cheek One bore only.' The 'rest ofisex{l'v+d Li baave i . ase + a. Par } Dndat„tour::! Et34&6e Tank .-cg.m.. P-0. Pas 944212 f.cr.-+m i Lo, CA 9s.-0-
<br /> Px*le, it case type is "QL>u1.0 G7acer T au.-Carzel t..tu 1 d ral)aT T`. `y1 0 -
<br /> Ln. Y,be status o£ t:,}te ground waLVr�lyn•:estftAti::n or leauup�_a, opi,,tad Ch' `1. 'R,riciaL Oaten Qual -ty [' ,1 Bard '
<br /> Viet of soyl,-. Deaeriotionis bpi"coil folei ow:_ 4. t:cal qas_th-:�..A.er and :nty 9oaid "opal t , r..
<br /> 1 i'wns. v
<br /> No Action Tanen. - No aettuy lies bd._ tan eoy 1 .:.pons ibi pity :>pyoly! - > e -asp 1 LF p - ty "
<br /> tnitrel repair of T-ak.
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