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<br /> r C!4iPGrkCt' iera CURRCST SIAT S
<br /> ;ids r wh iter, ,ye cy reslE€nse 'j,8r` nnel and equiltvnt wera involved at +.=rle? F h^ .L o y c�97ch hest.- c5cr3t� s r.hrE ;urrej st? as of the we.
<br /> ar,,;�t'ne. ii so jx l?az.irdous Material 1MM It Rel,rrt should be: f'iled�with x ChecL,wle bo, orgy; "he response_ sho Td be rel3ti, to k}t case type. Cor
<br /> %E Stay Df;tce?•of�' U"FS) t 2$C£1 ? 'ddD Yi£?Yt earl,, I r exam3h, if'osetfe Vis. �` rp�pd�i�r3Lwj, theb 'TurtE'h SUt:1s" cholid r_Oer to
<br /> j A6.raMntj CP�M .�
<br /> S32 -.!;a;,ze��`t>P�L'rte-MS reliart,.fok r11he ot:f_ainat ed your'. .i the status of,y. gr0 61 water iiMCIgaoo, ar dear€, ;is opo'ps(d to that of,
<br /> �e(3!' 'nc,'er.�i.Sit71'1 Stardg(? aank ,8rjr't rtiRg dCgeitCy.� rndicate uheiher Mw ME � k � i SRil.
<br /> report
<br /> 05 h cn iNi'e_' as of tipe dap or tMswyort,
<br /> rAF10RTAHl':"TFC F f0RN-1i0N P VTDF-9_Lt' TIS FQ0 1W UD = R a.ti;: U
<br /> O ' AG C TfiTiSTir rtERPOSFS C1st dJ tS -T TO BE C.1iiSTRlEFf3 AS ?FrrCSE�xi "l 'fHE
<br /> 8vo r{d«.lt a e .lot',f,c.._°o l rlunr#erlt .c deal*t ar,a Safety Cede Se slots OFF:CT.,t, PGSTTe,,t. OF A Y G 1 El?ti,1EST=€L Af h,,Y
<br /> 2515 a €i s E=.€te #overn n i' i:raf 's E Auld sin Md Uatc this f,, A . ' i. .
<br /> AMS h ick. € s gnvit3rs h"o du o nr n tha: - leak has been d eri;lined, #�RrE PHIAL AUIOr! I
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<br /> �. rte r � rt significant th,•oa,. *..tt lei;riar+ '�ealtn ,t�^ ,afc'}> Only �.E3at !aC1Fic�ticrt "ttli,;a rhieh ac-tirarjs have b€?en�ttsed Cv e4ean€t;3 or nc lc'ak.
<br /> I• un f„l.l uw d if reuu•r2d. ; Gcscrs v oris of 3s100E S i'0110=.4
<br /> �r'�CRtiE. ES -i Yr' l7
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<br /> Car S tq_ - nsUl I tic>,tzu"I ifrper,,nablo layer to reduce roinfal l
<br /> M r4t_r yfr Y
<br /> nae, eie�hor;^ htf77i}er, «nd address. indiiCate'. wpl li psir y :a(li; i,�r brat"ipn. y '
<br /> rep €':snt and provide rsmpany or, ager y nate. � s � Cont,tinnirnt Rarder0 install vertical dike to block horinhUl rnovewnt
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<br /> E;Ftt1� 3LL PAR Y Excravlit a'^ci Dt,nCse - reltove :;onr r,natvd soil and Oi pc5n i,t apprruved
<br /> I ;'?"L( ta-M, c A1,)rtC U_b" cu"Wt l)c, so and address of the }arty . S f _ _... + {
<br /> �i,��1r. .s h I e or the leak. Th5 r2->Pdnsit:le party would norEral, be t€la tank , Excavate wo ,r at mM='con+,Wnated soil me '[rent Bila ,
<br /> +`�wn= '• - I Spl t"a'iz - pr �J. iiTr]r!tln�). � - ,
<br /> R X F RL11ove FrcF r IGuc t re+'aov€:'; Oatirg proract_freer water . f
<br /> LEjQ �,;Txt €li r•vpN.tty the tank `3, lity wd saUUvn0nq area. YU I ! .. pm) 'in"', 7 m rosn&ee- nnerdE 3 ^piaycxr+ to rertav^ iissolvr,i
<br /> 'Vigil's nJ e.
<br /> , You "Tiu5- provide.. ih. ,a„i_lt ,} mole La d f'Uil ad(rrrsS. � k � TWO?!tT:fCt�c 4-. � i
<br /> En a,�:M 64te radataon - use €f.ary "a3laX vc"clagy to ormote
<br /> MPUMMIAM A MES k act rla'- Eec€tmpas t,c,r, of rc);tc'iR1n nts.
<br /> ':.nt na 5 tji� cca' agency and Re iernal Coal i ty Control ` and I Rn lac Supply+ provide altprrattvE wa?c; up;ly to afFee+.tr
<br /> ( lrnn nunt 't ijUo Kiel' - instelj Y,'d f•f. ?"Yeate+ent dEYir„E?S at eclCh dwC"-1 l"I Yi g ,r
<br /> �U13r At°FS ttasrE,VF„ F E afher place of a5n
<br /> riC r ths, n ee .Ett� €r��ntity lest Of _w f;;,zr:IAM subMvifire ins:t;;ped. Raim is No kAhn Rewl cd - ircilept is Arian rewiring no
<br /> ;i oil€ -- fo- 09"Pl'� i" or N6 "Ktawes if appr(pKats. if more than two � r` - 'eredi:3l a;•L�E,n.�.
<br /> I.E° esE' E' In K- r, list tl'r two of r,.;73t �',IEr.err
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<br /> # COWMEN 5 - Use this space to ,labor-Ae on ar,y aspects of tr* incident.
<br /> ,,COVEY iABAEEKNT f SM69A-7 Sign the form in Un spa:e pi-OAAi.
<br /> r,ar04 £tP -.f Tt_dttgilt rp rding Lite, discoYnry so ah wo of we lnk, CI��RFMRUT- l't .
<br /> attLru r ('AUSr t if the Eam is by Late La!'tk ebEnrr or his agent, re=a4n tl^Lz las* copy
<br /> n€llr,50, So€€rce(sl cf leak. E'iLovide de:a'�`l5 tin t,ark age: +apacity al d # no farwad do rmain:ng copses in tact to •yWour local tank permR ing ancy
<br /> ;nat�r`ia? if known. Cr'r" box{Psi indi;ati�g cause of leak. � for dlsvinuMon. , � #
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<br /> I. fr ag,g 1 E o.:al Tar-k nr itT.ittg gency
<br /> I $At? ]Yater Resacrr es Control Raard, Division of Water ruAlty,
<br /> ind: ai: este cay Vpe catz,orp fol' Lois ]eras. GhPck One [)o; cniw. Case type f dr.i,>•rrnii d Lank Pr(mh, P- V On IN. Sa qwh , CA
<br /> M is bio ed on he r:.os r`sitive rt,soure affer� rd.' For e�anrj le, it tenth soil 3. R Esonal it;r"c r,u It+.y 'o trot Board 1
<br /> ,dei g , ar,d a; r hAJ^ 'e.•T arfr'teti c,' t c will he fou d.,katc?r",r F A. CoFln%V ]iiia of Sp or des?,nee to rece.-iva Piopasitinn ,'i5
<br /> "in h€� e 40rinkinr dater" en1'r aifi ant or tett runictna1.or 3ars 5? c water. _.� I ngLifi_a*•.ions. p i i
<br /> is have ac Ually been of CC(ted.,FA F.GrUlllid k1ter�t&sign[l,iom ave5 'nJt� ... �. i}'merimspmsible piny.
<br /> j111pty +stat the.affected Water cannot e. ar in not, rased for dYaat 5g GA", �• � 4
<br /> S'h" f rilti that:va er Yrt'l w sav BMW vn been affected• !&i 5 -
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<br /> �C�dS� L pA 1?3a� Cfia q({ U,?0E'. E`u cher
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