Laserfiche WebLink
1000 <br /> 11CROU1�S' �QC tlt�'f' 1FiiE?RELA (LEAK)i 61"AMIfiN4T11 Sm#DEPORT <br /> EMEJIGENCY HAS STATE ;Pit' <br /> REPORT 8YE8" [ YESHD � . 7 # 11GCifRC . <br /> REPORT DATE CASE at 7 P #F I E <br /> • s <br /> NAME OF INDIVIDUAL FILING AOtkT pF1pJi� ..t- SIGN <br /> m <br /> Q OWNER/OPERATOR RECiiONAL RD ' AME <br /> Q sem` <br /> g AGGNCY Q OTHERoel <br /> ADtMv <br /> `� Lam!► S <br /> r <br /> w , <br /> Tco <br /> NTACTPE <br /> JarE <br /> ❑M ) <br /> a <br /> w _ - <br /> STRE�T CITY: WATE <br /> P(`f APPLICABLE) <br /> ' 'OP&RATQR PHONE <br /> jog/snAee► crrY co�urrir�.af <br /> CawassT <br /> z� LOCAL ANJOU AGENCY NAME CONT—ORRSON PLANE <br /> REGIONALBOW <br /> _ <br /> � � P►IbNE) fJ' <br /> (1) NAME ouANTtTY ) <br /> WE <br /> W HDrR ,"�.. �INt �] NUI$JHiK��DfiDR10N6 <br /> 12 , li f.I <br /> _,, . 0 TANK TEST'. aAN1(ASMOVAI" OTHieR <br /> m DAT$ BEGAN (ilETF10D USED TTJ 87dP ALL THA f APPLY) <br /> O AENEIYE CONT�It:LOS1r TAWB REMOVE REPAfR POM1Ct. <br /> Lu vt <br /> ftHA <br /> BEEN STOP <br /> `PEfl1 CLOSE TANK i FILL Mi PLACE Q <br /> IQ ND YS.LATEf a <br /> ! fPLaTAil OTHER <br /> SOURCE OF ISCHAR©E <br /> Q TAW LEAK KIXJKNQNtNr7 OVERFILL RUP RE/FAFLURE SPILT. <br /> I .k PIPING LEAK 0 OTHER r� bORROSION UNKNOWN F--j OTHER <br /> UNREfERMINED SOILgulf ONAUNDWATER 0 DAq+i(MWATER-(CHECK ONLY IF WATER WELLS fiW ACTUALLYq ECTED) <br /> CNECK ONE ONLY < <br /> Q NO ACTION TARN 11Y WE WPLANIUSMITTED Q " POLLUTION CHARAOTEROJITION <br /> . LEAK OEM CONFIRMED WSiTE ASSLzB>' iT L)l%RWAY- Q POST CLEANUP MONITORING tlt'P! <br /> Q REMEDIATION PLAN., <br /> C {CLEJWUP001�LEQCR,UNFIE�`E$BfiiA .: CLEANUP UNDERWAY <br /> CHE(*V*ROPRIATE ACTIO M E)tAVATE i DISPM{ED) C3 REMONE FREE PRO6UCt(FP) Q ENHANCED BIO DEmooiaN n <br /> 1MES.asraRoer�ur ;" ., <br /> CAP SITE i'mAVATE JJ TREAT(EJ) CD'"PUMPA TREAT GO NNdYVATER(61)❑ REPLACE SUPPLY(J� <br /> CONTA TIENT BARRIER(CB) a`NO ACTION REQUIRED QIA) TREATMENT AT HOOKUP 044Q VENT SOIL(V� <br /> 0 VACUUM EXTRACT(VE) OTHER(OT) 1 <br /> i <br /> W <br /> V r <br /> Hoe 051&" <br />