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g S`�STRJCT_GINS
<br /> EMERGENCYpi ENCy - - CURRENT SIAIUS [.
<br /> t at,'. whether emergency resr:rrnse persopnel and equipment were involved at .4 rkdr C c.'t.. thC^ category which best describes the :current status of the cc,$e:.
<br /> any time:, if so, a Hazardous Material Incident Report should be filed with Check One box only. The response should be relative to the case type. For
<br /> the atat.� f)f iee_or rx:rge:ncy Services IOES,'at 2800 Road, �xan,,,t , i� case, type zs "ur and at_r then "Cu.rent S
<br /> e - ter r tat s" Should refer to
<br /> Sacramento, CA 95832. `;o,.ies of the"OTS report form may be obtained at c your the status of the ground water investigation or c�keanup t�as oppos;d to that of
<br /> isf£' ;rrd=d storage tan§ aLrftitt (: ??C .. Indicate whether the (ECloc sol l>
<br /> report has been filed as of the date of this report.
<br /> IMPORT ANT: THE INFORMATION PRIOV DED ON THIS FORM, IS iNTENDED FOR GENERAL
<br /> LOCAL AGENCY ON'Y STATISTICAL PURPOSES ONLY 4ND !S NOT 1O BE CONSTRUED AS REPRESENTING 1HE
<br />�' 1'o ova d dtt'a,ca..e nct.ific,,t on pursuant torm3tealtn and Safety Code. Section OFF-11,I:AI POSIT;;,tti OF ANY GOVElltl''tk4T.AI At,LFa.Y
<br /> a nesin ated governme,il employeeshould s gr< and date the form in
<br /> tf;S hioc'- A signature here dDea ..o'.; mean that the leak has been £ieteriiIiner REMEDIAL ACIION
<br /> n 4a. Eich a{;tions ave been used to cleanup or reax.'.dka.?se he leak.
<br /> ti's ,,75 significant threat tf3 ht.tf�?€" t r'altR or safety, pr,}y c,lidi nr>tt f't Cra'�?Ga!1 T' } S; ,a a t�
<br />€ procedur,-s have been folluwe"d if rdtulred. Oescriplions of option's follow,
<br /> r2E.1O..T€.r) t3Y Ca, �Shoo - install 'horizontal impermeable layer to reduce rainF0l.
<br /> l•.Y;ter.your name, telephone. number, and address. x(S Eiira Indicate which party you knf E i.rat?£in.
<br />"
<br /> represent and provide company or aa:ncy name< Containment ahnaCrrier install vertical dike to block horizontal kaver •nt
<br /> of nm
<br /> RESPONSIBLE PARTY Excavate and Dispote - remove contaminated soil and dispose In approved "
<br /> Ent E. <,d:a?., telephone number, contact. ,person, and address of the party 5 te>
<br /> responsible= for the leak. The responsible party would formally bi the tankExcavate and Treat - rotxve contaminated soil and trent (includes
<br /> r.
<br /> owne
<br />,. . .. Sia r'f:adr ng cr�a3 r,d faratk Yk�}, ..
<br /> rtesove =ree Product - revx)ve floating product from.. water
<br /> SITE ILOCArION
<br /> k:n`r n,crmation regarding the tank facility and surrounding area. At a Pump find Tre=atGroundwaq r - generally employed to remove dissolved
<br /> ._
<br /> :mir7kAu;ka, you must proviFin the #aci)kty naeti? and full address, kunts_.
<br /> . ..
<br /> Enhanced Bic'eggadattion - use of any available technology to promote
<br />" IIIPLEMENii4t, AGENCIES FTcfe75T1eDm,oTM-56, of cpntamk roots.
<br /> h . nar•)es of the l6ca, a0ency and Regional Nater €)uality Control Board Replace, Supply - provide alternative water supply to affected
<br /> volved. lr} VE(1 irea ont a eHookup
<br /> - install water treatment devices at each dwelling or
<br /> SUBSTANCES Ia e ar,E n€ant}ty
<br /> lost of the hazardous substance frlvolvrt+. Room is o tetk;)k R-, ulrc.d _ inc74,'ept is minor, requiring no
<br /> . ..
<br /> arusku€-d for information on tWf} 'Ubstances if appropriate. if more than'two ret dial a%trdn.
<br /> X s:i35 u9 ..
<br /> ne`.i le:aki'd., 'list the twoof'.rd.,it concern 'for,"...€.t? L[p, ..
<br />° COMMENTS - Use this space to elaborate an any aspects of the incident.
<br />-` 'SCOYERY ABA Ery"ENT TITVA R - Sinn the. form in the space provided.
<br /> CrcvTd� €rf rtaf€re, xegr?rfk=ng the siss,.nvr?r, and a!a?te)nent of ?.4kex leak. DrS1R i3k37f,;Pd
<br /> i t),�rt USF If the form 's completed by the tank owner or his agent t the last
<br /> SC3UY°Ce?i1 i"' .1 ?t'>`,. }a-: t t
<br /> 'i., aS Y
<br /> i<cv} r e ai s ork lark ag£. r..p<acity :an and forwardthe remaining copies in tact to your local" tank rerkiki'tting agency
<br /> " irate,<ial,jt k own. Cleo tiox!,, indicating cause 6fleak. for distri ution.
<br /> 1. Ori9i"aI - Local rank Permitting AaE-ncy
<br />< `�rSr TYPE "2.. State Water Resources Control Board, Division of Water Quality,
<br /> nd) at the, case type-c:at=gory for t,'ris 'leak, C e:k orae box only. Case type Underground Tan Program, P. C,. Box 200, Sacramento, CA 95"011
<br /> is based on the most sensitive resource,: affected. For example, if both soil. 3. Regional Tater Quality `:ontrel 'hoard
<br /> cinrj f z water have been affected, case type. Wilt be Ground Water". {$, CEAktnt}� IIdBr'd rf St.pervi errs LY :!e$'El:ief? t{} rn4f i'Je proposition 65-,
<br /> lndt€aye "Drinking Water" only if one or more municipal or domestic'water notifications,-wells have act ualiy,reen affected. A "Ground Water"€ desi'gnatinn does not G. Ywnerlr'espo€)sihlz pa ty.
<br /> 4€a)k th.t the . -f.
<br /> i r` _ a< C 3Y:? trd w;?LEr ,ca rknoff 3#?: dr_:.}c !rat '€dSE`d fir d r i nkr nig�wa ter,
<br /> tintf,nl,3 that Water rites, v rtEaty L hie affevte i. itis u€tdeTstood that
<br /> case type Maay change Moon further investigation,
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