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<br /> limallvvbctm, rrWrgency n"Pen. Person"! and 00"Mm v e i"olvel aY MAY UNTawgry wrich ant 5WAKStat 'r:r so. of Me Cue,
<br /> rft S .:, ia.e r ..}q lh3t r'' ? I P o t should ,filed th C bo only. r e i o f the w "o For
<br /> the Stott Uffin of y ..c,.n"y Ser .,Ls Gt 2�,KQ flosdowv:ar fat s, e .n,F,.c, .` Cash, t:.rte is c;rovai raa}U=.: toe, would tar to
<br /> aa_:_'r,et .5"32, Copies of the :-s re o a Porm may be htalfa-d at you:" tre s_ tars of the grown water incstigaVcn or ,.ha. p, an oposed to CUt 0
<br /> r qr,?^. has bun Abu an of Me t.s to ot trr s r pra.
<br /> 114KRIAMP ;rr WHIM&ON PQUIND ON THIS FN, ... _dRN;,}rg, ...2iA Yp':..,,
<br /> aoCAL SMTKTTh� f,LNS9 01 AC N S ,S t... ,.,1:..,._. Pew �F<it,_ 3.N;,tdfi, WE
<br /> 1 : t an .tFFIF_,[ ee..,a s, tsY' n,>il ;�4�.-;„k�;f?.€ ,,.�.,.;
<br /> £;, w} ._ rid>.i udT_ a £,v?'5t=:.<xi' Q ..�s�<., ez .3;-.iy ?.aC'*' :i,:7?'E
<br /> 2518T7, ACpP d...e Wn"Wenn, employee Owuld sign and a2t. M° Taw r=
<br /> ,r threat t vo,< r r ,U`c ,, n,t uh., notiP cot,:rt nt7L F t a ! u-_ o!"up or r_t�r i;gt rh L..
<br /> a rroocd.ares .eer} ,lowed +t xlfj..et GC. Da &,P"tions of "Hum follox.:
<br /> r rR cD BY5261 horizmal imponvable Ham to reduce rain.
<br /> which party too Ty
<br /> 5
<br /> ..pr�isent "'no, ��v y,S.�Y [ l-'N,.y I .f,: t .30irnu. n 'l� Be”H r '^ Frt 111 =f'1 .,u- dike, t, t3 �......� .or sor-.al inov ,_ant
<br /> EFE61141NE
<br /> Us at r°t,t.,>,: c;; _ 1- t_a t� d _� �: , ,}3C5,. ar uv
<br /> � r
<br /> K
<br /> a _5 ef no prt
<br /> wo )d e.,>mal I v, :3c, the ie'-�k Fwavue and Twatruorw c tr.d,. ri:_t;: __ are, tread s nclu es,
<br /> r,.> f..r.:atim rogaying Me tank facilityand surrourWing a-ea. At a Erpyq no GrowNave - serer _ galoyed to r"nn rVissalved
<br /> mEni,r;r.r p yo3g. 3(nt Provide the facility r.:._a and full address. -
<br /> ,- Emanced sr}d,EracEwn, r. U. C, ar "Alowe Mennoloyy to Promote
<br /> VIII N A00511-S, ss sir r rtr� f r ttarrE,g ,
<br /> trt.r rr;i es ut tfi., veal ase ey and dtyttgm, WAer C,.alitar Control Board A irca 4 ugyj preside al crra .v= Mate, supiult to affected
<br /> involved,
<br /> _,
<br /> i"t&' wart r Vedt.t(en devices at each ("wellintj or
<br /> c ars i4`,r S 10 e�rt rf ,a P a` ruse'.
<br /> a Ce tst. 'sr,, "57i,
<br /> ,, ,}oaptit, #..}st of tw ;razed€zus subst n.,; i"olune?. Room is No Action ccs? incident is minor, wdring no
<br /> pY'i3t7d£"'ri fornformati;n on We substances if ,.j7p1"ogxiate. >i more than two .GV._,u< , .,E.n,..,..
<br /> s:.Ot 33.ss Nakao, lis-, ino two of miostconcern fn's^ clo'n;p,
<br /> i„='mys - UW i,t; S S„...G`W to P.,.c bos`a t^ on iSttt awn” of the t?1C;7tlE;'tt.
<br /> DISCOURYMBATEMNI S115NIATURE, Sign, the forms in the spacc wovi°r�ti.
<br /> T' 'VCoc rn,c>=..xrarri garbing the, di.z'Covery and abatomcnt of the weak.
<br /> 7s c:s,n},�' d �r:y He nk owner :o H, apo, ruain the las., C0Q,1
<br /> c{fnf }�-sir If tf as rv,
<br /> aat, rc:e(a I, of, leakProvide details on bank age, capacity and' and f}rwnd the rwa`no?_t copies in tut to your Aral ;ink in"€r ttin agency
<br /> material if `✓,II wn Chew Ann es) indicating cause of Bak, far d tr oStson,
<br /> ?, it .owl - local rank Permi"AT Agency
<br /> `AU TYPE 2. Ste" utter Resources Contrul Board, Division of Fater Quality,
<br /> lif"at:.dto case type c�Es� r ;>>° this leek. Check one pox only. rise, type
<br /> lmd rgro ni an �r gran}, P. r;. Box l0f, Sacra,entc, CA, gh)8G
<br /> is based on the most cen.tive ressurce affected. For eumple, if aab soil 3 Regional Watw Qualit,,, Central Floard
<br /> and r>=.,,;d wat" haw {.uen allnAC cah 'Mm wil 1 ', ' mond AtW C County Board of Supervisors or dwipw to rnpive Fr"osittcn 65
<br /> r u to Thinking Watt n3Y if oriQ or more mgnicipall or ceo'rest'c water n�trf: at,�ns.
<br /> wells how actually been affected, A gourd tsars' rlcs£ rsa"on basis rot F. C�rrE,j a , o?rsihla ,arty.
<br /> =}tp Malt On affected water .a not re, or is not and No driAina water,
<br /> on only that. water sells have net, ;ret leer; affectel it is ade stood that
<br /> rose t,trr. =,ay change 000n ,t th r invn;tiration.
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