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I.ie 3TRIXIIONS
<br /> Ela,RGEN^Y S oak �3e�zx iif`i,r;acd Leak suspected at site; but has not been ccra_`i.rt ec.
<br /> ndicare whether emergency response personnel and equipment were „nvolb>ed Pre?aw:Jnary Site Ass-e„stmenu knLar ;izbm%ttvrE - we ks,lan/propcsa,
<br /> at ally ..Me, „f so, a Hazardous Materval _nc€dent Report sho ld be filed requested offuubmitted by rezponsill le party to detersn nae w1hether ground
<br /> with the State Office of Errorgeney Services (Qs,v) at 2800 Meadoirview Rad, water has been, or will be. zm„a„ted'as a result, of t1 velease,
<br /> Sacramento, CA 95882 Copies of the GES report form may be obtained at P e-dAminary Site A :;e s.nen.. l,dezwav isnpletr,.ntat-son work _a^
<br /> our loca” underground � � g agency.- p.. .
<br /> y .� �grr>us.d saora�e i�a:;k c it.tx: a e>.^ indicate whether zaZlaxti��s £;i:ar steriz� o»x � r�,.vua.�5�,s�?e �a t� is �, �%;e� ,xaca,,a of f,u11;
<br /> the,OES retot has been £zl.ed as of tate dat,o of this report, defining the extent of cot,tatnination in soil cod ground r.rNtex and assessing
<br /> ,pads on surface: anelor ground wate;r,
<br /> LOCAL AGENCv 01N.v Rerre iar Jon Plan. - remedmati©n plan submitted e aivi •nglong term
<br /> To avoid darldcate notification pursuant to Health and Safety code -Section remediation r,;stions. Proposal and Implement;a'tlot -schedule fczr appropriate
<br /> 2f1LJ.:, a gbvern�ment employee should sign and date the forts in this block, rc,nedia son options also submitted,
<br /> P signature here sir+es not mean that the leak has been detertnzned to nose a. Gleazxaip Underway implementation of xenediatjctx plaza.
<br /> Significant thrnaw to human health or safety, only haat notification P learn zp Rlc xxi or z. an P o t.e periodic ground were,, or o':_,e::
<br /> procedures have been followed if requiredmonitoring at site, as necessary, to verify and/or evr.lu e effectiveness
<br /> of remedial.. activities.
<br /> REPORTED BY Case Closed .. regional board and :ccal alias:cy it..'conctizrence that no
<br /> alar your nacre telephone rumbe:r, an address. Indicate which party you `tarthez work i ean_,essary at Line site.
<br /> Adhig?present and prav<de coin,
<br /> pany or agency name,
<br /> I" ORTANT: THE INFOR1IIATLGN' PROVIDED ON C� FGR. IS INTENDED FOR .ENEII.AL
<br /> RESPONSIBLE PARTY STATISTICAL ,URPOSSES ONLY AND IS NOT TO BE CONSTRUED AS REPRESENTING THE
<br /> Enter name, telephone number, contact person, aiid address of the party O'FFTGTAZ POSITION Ua' ANY GVRTMMS'TA AGENCY
<br /> responsible for the Leek. The responsible party mould no_m-ally be the tank ,
<br /> owner, REMEDIAL L ACTIO
<br /> Itxaacate which action have been used to;cleanup`or remediata, the leak.
<br /> SITE I.CATIoa� I),srriptio s of captions fxl,low
<br /> Entex information regarding the sank facility. is a minimum, you must
<br /> provide the facility name and faa1J address, CaL3 ,�,ite - instal horizontal stt?I>ermeable Layer to reduce tain all
<br /> ;n�filtratzon.
<br /> IMPLEMENTING AGENCIES Containarent .Barrier - install vertical dike to block horizontal movement, of
<br /> Entex: narr<es ref the .local agency and r 1.
<br /> _,es>-rn�:_ �ea�..e_. �.zat..z.f;y Control Board t.oaaua.r,�wzant.
<br /> i;avolved Lccavatu and, Dispose : -remove contaminated soil and dispose in approved
<br /> " este,
<br /> SUBSTAY Excavate and Treat - remove contaminated soil and treat (includes spreaed'_:ig'
<br /> Enter the name and criaantity lost of the hazardous substance Naavu vc d.. Room ur l,az?tl fa.jai g).
<br /> is provided for .information on two substances if appropriate, If more thard Rerro✓e Free Product remove gla<_Ling product from water- ,z,,bl'e.
<br /> two substances leaked, list the two of most concern for excazxzzta. :rumn and Treat wa - gen..a c: . t .=ei
<br /> � .
<br /> DISC.OGF:RY/ATATEPE NT Enhanced Biodo-mention - rasa': of any a ra ilar..e tsec poi_=agy to promote
<br /> P.tov-de inforalat:cit regard i.x,,; ti,e d.scavery ana ah tenan of L a 3.ea acter5 a: rlecnrps ai,iea.a o� lo.tar._nants.
<br /> P ac y provide alter tove water er i pp.l.y to affected p in es
<br /> w ea_mo L a .'oakuo -' anstali wattst_,eaty ent, devices a' each dwelling or
<br /> d+_t.aLe
<br /> source(s) of leak. Check boas( s) irid catang cause of leap, other plz",ce or. use.
<br /> Vacuum Extract use pum.ps or blowers to draw air through soil.
<br /> --,.;F TYILE Vert Snow - bore holey in six._ to allow voiats.taxation of contam..nanis,
<br /> Indicate the ease type cetefory f'or tlxis le k, Caeck ore box only. Case �?ACt,iix aced - ix,czdar.t is rainor, requi-ring no reme r ]_ ac—on,
<br /> type is ba-:ed on the Ire t ~ensi`.ive .resource aff.ec.,ed. For example, if
<br /> hath .noel and ground water O,"
<br /> have been affected, base type wil. be Ground Cr'FN S - Use this space to elaborate on any aspects of the incident,
<br /> v;at,et"a indicate "Drinking Water" only :,f one or r.acsre tr<t.ici.pay or
<br /> domestic water wells have actually bear affected. A "Ground relater" SIGNATURE - Sign tl.7e form in the;space provided,
<br /> designation saves net Jmply that the affected wa`.;cer cannot: be, or is net,
<br /> used for driVeing water, but. only than -water wells have not yet been PTSTRT"UTTON
<br /> effected. It is undaxst,00d that cava type may change upon further of the form is completed by the tank owner or his agent, xetain the last copy
<br /> xva tigstion. and forward the renaznm copes Intactto you coal tank peit,._t J*ng agency
<br /> for dIatriw17, o 11
<br /> 2 ?_z€:nam - Local tr,.ak'Pexmrittini s_„ency
<br /> x.a._ afiwa the category which ...e :la cr_bes thy. current status o t,_e case, 2, Sat: luau,._ I,esoia4cls Control Board, Division of C_ca.a safer Pat+.z,. -.tars;
<br /> !".tr.e<„r.k one box only. . The response ;�t.o.ah.. be relative tothecase tyre-,- For UndergroundUndergroundStorage,Storage, Tanknx n.„
<br /> czr,<.t.., Pc O. Box �462;a2, S..,,�.ac,: ,xtu, ure `i4G14-
<br /> C
<br /> _ nll.e; if case type s "Ground, trtr=z then "Current Status"vt.atus" should-.refer 2120
<br /> te"� tier,= e,Wat.us of the ground water :.loss i a_ion or c;eanun. as rnvo;ed to 3, Regional, 'Water Quaa, .ty Co;at.^ l Board
<br /> t.aaJ vi zoic_ waesczin`ions of options follow4. Local Hea.Lth `_}ffi er'and f,_..nty .Board of S e.,vi,:o,> s,,. raw„,” Wesij,.aec to
<br /> No`_'x o `i lona - No act,itn,, },as ocean taken by ,on _bto party sati :._.? _a, i?7a s.; 3 1.'_ r<,.,,t, .
<br /> c;;.`
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