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EMEMGENCY Leak Bei°i Coi accred Leak suspectcd at sitebut has not been rcnfirm;,i.
<br /> cls'care whether" emergency. }ctwc _.c.n._e:i aia e i:pmen: were _ lvoD ed _
<br /> Submitted ua k la , o osa
<br /> at auy .isle, w1. d €sot a :iararrc� sal. ctdLiefi rd meqasa l � rppy eine
<br /> w_;ethe: zl
<br /> rvatnr the State Office of Lancs„ancy ku CAPS? ;,at 2£B0 €�ea:ltz�r..eti� `,i,<ad, waiver his-laeeia, or will k>a, a�t ,<. aK�t Zs a zn,,...;zlt of the release,
<br /> S ° 9,'x832 - � t ,
<br /> ,_e_cz,�sex_„o, ? Uc.,ies of the C)E: t.aii+ar -Foran may be r;vtai;ed at Preliminary y Site A ,:,z;_at, .,dus r7aY implementation of craakp"='l,.
<br /> your local undergrour d storage :ani i6rm t,ting agency, indica e whether Fol_EUtion r,r:, c.,eriza,ion - s ..,pmas ln'le Party in :,°h process of ful-
<br /> _
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<br /> ,.f z , reporthas-been filed ao�' the a.. c of tsiis ruse: x��aai g _.e�c con'amina:,.d z_: in soil' and;ground >a.to ;and szeszIng,
<br /> 7 t-.. OX Yrfac and/or s `o t �< c _
<br /> T a"AL AGENCY ONLY " kt nea_,� e.ra�? ,n,r
<br /> cir �ti. xz � 5, ava,ataa C Sterm
<br /> M
<br /> xCi-aV'O1ct Liltt;.l.k.CdtC^: notification pursubait [fa't ealth and Safety-code Sec`'19� S remediation options:.. Pro osaL ander..
<br /> ,
<br /> � , - e
<br /> Implementation'.enY .:L2 _ �
<br /> 4:�'e a_ app v.1za,e
<br /> 25M5; a Yovernmentemployee should s�ynd a e the fo-7in t1iw11oc:. rne.iv�>czoptions also sibritie: .
<br /> i'. signature veradoeo not tajean tbat tho ras keen .,
<br /> det,,rmii'e ? ruse a Clsenlu odenrwav -- implei:.e°.at�ai ion of .-.cmedxat_on plan,
<br /> threat to hutnaa health or zdf(;Zy, only that-notif,,cation Pr >;�, Ole,anu '9oi_t,,rl periodic ground water or other
<br /> procedures have been followed if ie(luiredmonitoring a., site, as nec",sary, to verify and/or evaluate eafec,,iveness
<br /> of remedial.. autira i s
<br /> OPTED PyCase CI .gi a board d cava_ a6elacy in coneurremce that saes
<br /> ra11 ter you nave, ;;elephraxae rlrb r, _ ,.
<br /> and aauea.'„indi.cate which pa,ZtY you further work is a:ece sary at the. ante,
<br /> present and prov.ilde conpany or agency name,
<br /> PC;r A T: THE INFORMATION PROVIDED ON �
<br /> THIS POEM IS INTENDED FOR GEIN RAL
<br /> zPC)teSIISLF., PARTY STATISTICAL HURPOSES ONLY AND iS NOT TO BE CONS RUIED AS lz.LRRESxNTING TH
<br /> Enter name, telephone n rbe collar,. I ersozi, as d'adelres t ;a ; ' �n a=T
<br /> t � of r.,I� party F"ICIAZ. I'�:ii'T1C)'d ANY G����Iv,.I;_, A , �;CI:'.7;'T
<br /> responsible for the Isek, The re;sponslb:ce partywould'normally be the tank
<br /> ludic to which action have been used to c:eantipx.or .rexrediate 11 leak,
<br /> :_ 70CAaI Iv Descriptions of options foliriw_
<br /> Enter :dztfq ation regarding thetank fee Jility, At a Brig rat: m, y>4x :rest:,
<br /> provide the facility name wad 'till address. Cala Site - instal horizontal, imP,-r:,zeablo layer to reduce rainfall
<br /> in i tz.ztion.
<br /> IhP EPETTT G AGENCIESContalnia.t; Barrier - ..t:sta a sciti.call dike to block movement of
<br /> { . - ,a. Quality Conn. of Boar-d' convailrinant..
<br /> Pn WE3k names a'f the<�_ou�al <>ca.c and Regional raato� � --- ,
<br /> rxavo2aed, k cavah,. rz, _eanor,_ wvz;t,atrunatod snit, arta dispose in app.cajca
<br /> sits,
<br /> Sfi f�tnc'�u T3v t)LV,17 >c Y<z and :mea, - wcanove cozaw... a>,at,ec4 Buil. andtreat ;s cl Jes spjeeti,'eg'
<br /> ;:,at,er the name and caant;iuy lust of the hazardous substance iirvolved. Riosia- o. land :,Tmine,1.
<br /> is to cat ded for info na:won ca:: ?xro w t azi„ s i.f' appropriate, if Mol _,a:< �mm�i�e k� i3ac -., remove .lout ng is,.rd dct from wa cz: ,.at I
<br /> two sub_,taixes leaked, list the two of :na'al concern fur cleanup, _n eat Groundwator - enux-aily sinplc.aYed to ?e"move u.,,WS.rLved
<br /> iri*C Fal /nJ h2,KNT it _ -- z a : s ax} a t<a a., teWwiziolag to rc.,za;
<br /> i'_" id_ into.,,mzL;osi ,egarrli.l,, the ,darn>ery and ataltement" of the leak-, u_.utez.ia'v .,escomposinion c,z contaminants,
<br /> Ss s ,L p .a -alto nave w +ei slvpply t7 affecCd u._ t
<br /> fi,L itizFICA e n_ �u I e - anatsll water t,a c.,u,:ient devices es at each dwellin,;, or
<br /> dic,ate solurce(s) of leak M,eec_k noxCes7 indicatIng c„sa s<: of leak, other :ai sr use,
<br /> v .az jun
<br /> aF YPr, n
<br /> ,
<br /> + cl e pe_as csL� iE ;o dr
<br /> air thr Sh soil.u l :
<br /> Vent, Soi rore holes n soto 931';OW vo= cn of conLamlnants,
<br /> Lndicate the, care type cave viv for this Inalk, dheck one i tau iAc .ieiz rno „mea �l _c
<br /> t
<br /> typet~ 1..ad or the most sensi,Jve resource affec-ed, For,exeup:a, .
<br /> both soll and ground waterhave boon aff'e'C ed, se type will be rriu d '"HnEN"SS 13se this ,pae:,e to alla„c,„ate .an any. es_ps.cts of this isac.j.deit.
<br /> ease
<br /> nater..,. ndicate ` rinkirst, nater” only if one or more mtiniri.,a.l or
<br /> domestic water well's have ac tai+y been affected, A "Ground Water” SIGNATURE Sign the forin in --he space provided,
<br /> designation Cosa not :r. 3 = that the affected water cannot be, or is nc,,t,
<br /> used for drinili.ng water, but only that wats' ,_ wells have no; ye` been L';',P,IPz7:!0N
<br /> affected, It is understood that czasr-, type znay cha, e upon
<br /> xzlie f the form ia completed by the � owner or n aveeli zetain e sa opY
<br /> a
<br /> and the remaining cop_c., izt.,, t�'t3 ys zar _c a?-tank permitting t,vrat n,.y
<br /> tc,r <l1,st "i))-A,.crn: .
<br /> saI ;'_ STATUS
<br /> -"` h orig s a c a I Tank rex i,.t,t i a; Ag ny
<br /> Thv"J_�,atq the cat.et;ory which >.,,.,:; d oa._.,rs tth:; cu_xent .:status pct ,,;.re case. 2. S .,L':. zd<i,.._ RestSl t,.n,atrn.' f^,<a.rd'., Divilsioti of Mean.Wza%U., Programs;
<br /> e•,k to e box rely, The
<br /> e 5 un e :aho lu ',:;a r. atrz re tr, thecaa.e }v a, Foz. C au gr s..�.," Storage Taar;; Pro rara, ,P,, Lax _212, c:,.a . 94
<br /> if caca; typ as G .v,sz.0 WaG the 'C,ta_.en, St,at,_.. ,zhould .
<br /> r .
<br /> the L a u z a ,a o cleanup, a _ }, .., ,.,o'. :?. T r 4u Co, Ba:ri
<br /> ,ti, z,a .,.cr re .a n _
<br /> c.- ., n p ,_, ,.a,, �w�.:ow; G, Lose` x a .__ Offix.er LndCounty !loard u$ to
<br /> a u l i_s., . .,,,;., on bl o re__, y xac.;,; i , c g x,
<br /> * c i ts,
<br /> h3
<br /> u AK,
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