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F If3511ta c faliS ' i R s ''
<br /> CURRENT_ 1TAe "t , �
<br /> ti.rttls�at whether artg�n,y r�.slaonsa pirrse;rrie anti 7.qs pE%nt were involve] n- cr, sca e crtegary hevfhre best ns xf scribeh the atiI;vrrvcnt status cF t-pf;,se. )�#i
<br /> ;ary 'tii e. If s , a azardo s:�1�terial Tnci'dI nt fieport. shou10 b), filedf*r the i Check one box only. The �espons Shoup he relative to the cri.. Ci'p., For ,r
<br /> 't'{e
<br /> State Office' met eney Sery .es fliS} at 2bJG n!nado4viavi Road,`" eKary)'e, if case type is flroundMater", ti,en "Current Status 5houf0'f�fer Lc r
<br /> E SicrsmfarrtA, f,Ay�iSB'i2, Copies Df rc OFS report Orin may be �litairsed aLyAiir , soilstatus of the gr+un¢ water iravesLigation or cleanup, ax on seciYs ttaat.Dia
<br /> 06c,'t .tndoligr"it4—s;-Arable tank permittinti +'get,
<br /> InticAt:e avirrthe+ t#re 3F5
<br /> r 1
<br /> ,gno�t f185 been ftled o the daft of this report., 4 p
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<br /> IMPOVANT: TxfF IkFOR A7iflti PROViOEJ lii TrIIS F014 15 I YENUED F.R LENEISAC c )
<br /> STATIaTiCAL P2f>65E.S UNLY ANO `S 1QT"r6 BE CQrvSlrtuFO AS REPRkVH`Slir THE
<br /> ;IC4'= rv4JCY CxLY: t * C ! W-HCIAL POSIT;�Y tSj" AUl G{tVFi.4%%T.fo, AGF,CY '
<br /> :Tp arot err rcat; netcoon pur5 )rt .o Heal l) rd 5afp y Code ect'on
<br /> ?S1 U.', a iesic#n3ted government trp)QyeP should sl* an€! dl* the form in
<br /> r,,:g• f, si natE)re iurs dt)es not mar that-,tlt�ieak]h)>been deyer ined i REAIF..IIIA, AC"IUM r
<br /> 1)p g c ! i ?rcTica+e wh�iF-actians have keen used to clronup Dr rein diate thr
<br /> ip pas a siyr:ifitrart thri-et to rum rt hc�lti, or §a Ltr, a,)1_ that nociFi ?tion
<br /> I .pro�ciures have bfprn followed if re4a regi• r lescrrpttons a` astions fol?ow:
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<br /> * "t Can Sftk, - in t:) 1 #toriznata� imperpaeahle layer to rc -<N rai'nfal'
<br /> RCPT}RTED BY
<br /> ;Ent�fnap-e. telephone nue err and address. indicate which ptrty'*you j�3�tration. �f
<br /> o j Con ail nt Rarr�rr rtigstAll vertical dike :a block hor'iao}t imovLowi�
<br /> °rePy�setit and provide conpany V,r a,enc nl � nr_ne. ,
<br /> .+it • D��QntaC)1)'dii
<br /> RESi?rFi rf-E PaR?Y Excavate i� fSi4 ren'ov cc,ntaici ated suet sand JispA A{sir'a�pI•oved
<br /> ErtPreu,rK;, trtephorc nwnbt'r, contact i)erson, and address of the party t sit
<br /> O,• t Tht resnonsliblP art •would normally be the 't plc Exrav_atg_and r ernove contaminated soil anj treat rrp6ludes'� 3
<br /> 1,:�sil�r,s4.31e 'Fcr tine l ak. 1 p r / sn,^aclri ai"J nd'- ariFis,q). s �c
<br /> ownr. * 1 3 i Re€trve rre Product renovet'Flflating pnoduct frog water
<br /> JSj11' OCATl'CN 1 t j k. table.- > ,�``
<br /> : ♦., r n'ri r Puf Ind T e<t Grp)r4wa t er -� aneri;lly e,aployed to r(=ve d SSD i r", ,•i
<br /> int r irFlara?tirrn �taI'd0i94hr., taslt f`a_iliity �+, s;'trrcundijr,g area. At A —_ g
<br /> t hn riar�-an -ful address I r Gonin,vnts. �'
<br /> �s,n raltt. Port `�U$t provide t•- Facti� y. r r r i t
<br /> rr Fnaan"d L3 e r� a��, _ a's Cf any av3til`ab1F techncloay tf pro. e ++
<br /> '.I+p IFIT IINS AGLNGIcMS" � � � � r bac*aria r�euir,.posit)gn�of. gntalaiglnts..
<br /> +nt€ jai t LIT th{ l cai 3ocnsy enyLRc3i, aa1 t6r jue.1fty Cotitro9 3varii ;- s ReF,iaCe Sbptly - prov,iid altprniti�e atter su_s'V1Y tc affecti•+� gyp.f
<br /> �ii)vUlvet'. . - _ t ja_ztni,,
<br /> ` Tr@3:Yi.ant dt 'la6ku) - l�[75tdtj wati'r' :re2trnerisl)!e4L4e.s dt each dwelTillg r<`r;,
<br /> �S�Ii35iANCES TSIV^ YEC C 6tti.nr pia a nl` t3ae: ° s
<br /> zno qu�atxiy lost oFj the ! za deus substnn: involved. ROOF is
<br /> r N¢ Action {_atirc:d - incideitit ?s ml nor, repair°incl na
<br /> prnvict;f `or inl,irnation on t1rQ suhstar es 'if a�propriat6. if mora than tvjcs rerae..ta action.
<br /> ,�Suh¢t::ncrs leaked', list the twd of molt cr,rtri) ;ror 0cdriup. Y r 3
<br /> M CO)Rlcy'r5 Use this spice te. ela6crate an any aspects Vii. the '.;zia'ent.
<br /> fr}75�{7 �SYJAE3 TFMfNT'` R S_cffA E - Sign the form in the spat?+orovf6d.
<br /> "Prot' €e 'nf�, ' reSdr4irEg4{he disdovflry 810 a'oapnenLsof the: l,,k. DI fat IUH �S
<br /> "of1Fi;E,CAI,;SE.
<br /> • , If the fear `s ��opl.etOd by ti'k[! tark 'lifrler Ar his dgPnt, re tali# KY list copy
<br /> .ridcai,� c,AI:'Cnfs'.: of re,)k. ..PtiA;i l(! df=tai s ari'xan are: ta;;a�ity a)r! and forward the remaining copies i^ tact ta.yorr lor.al tank pe,rrittiny ngenc
<br /> a nat.cr;al i+ ` r�wr� Gh�_f-tnxjes. �ndi,eatinq case qF leak'. .. for oisT.rihuCa{'91
<br /> tior,`,•
<br /> I s, original - Tink per•+itt'ing Agency
<br /> -Ik.A5f4� TvpL .4 ! r 9 { 2. State Watar Re5ourtes Contra' Boot-4, Divi5i.atk of lsater Qua'iISr'i .
<br /> 'i� iTIPLYh:• ':dsr''� ty�!Q��a'l.i�gDr� fAr tiiir. Irak. Check !)fieI)ox only.. .l;
<br /> . as� typo Unrergr•(;und Park ?rogrdn, �.� U. Col `i'0, 5a.cr'a)nPnte, CA 4513111
<br /> b _ate; n� d is t r.srrr ? affects i. fpr exirple, if ,)th ;ni' r I. Rn Tonal dieter Ccaliry ;:ontrol °card
<br /> an 7f'"flUYT�. .49t?1' iF'1n bF:eri.ra• :C.[. ( �-{`'3j' }'Fe.:I� � --'.'�r'1.L�?d �.?t1' _ County 3ndr� (�� SUwP'"ViSpr"s >?r dr'5 .9nen tz? eive Prvpos�4ro,i t;5
<br /> {-r dry htificat,on5e t t -; r
<br /> llr•ts,k),to°dater" 'o r
<br /> jyi ' �rrnr 2r nwrr munre pul }t 'imetitic wtr— ",4
<br /> `.,Ntrs .,-ate actr.al:% beplf �f�ec�c�l A rs*und i4atctr{ tl,-,`sirndti.on dons not. f � '• Ownr'r'respons� le party.
<br /> '.las t^„ �f fec,tie water-can[{,y,t be'. �P, is not, used`•for.drInk ayg watter,
<br /> +,.-x� nr ua1,7c ht>.tt§tna'MAJet tael�[1 Pf{@C'tei'1- i -end r tAod-that d
<br /> Case tvDi' ,� h n : u�Vn fu t'her'e v sti e o •�•- � "' _
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