Laserfiche WebLink
/ RELEASE(LEAK)I CONTAMINATION SITE REPORT <br />� �I 4 <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED R <br /> 10FIL Y CfAGE THAT I:Ash A f3ESIC IATE4 GOVfFF{N�4f M�U4Pl0Yt~E Ar1R.T�4AT 1 NAPE <br /> EMERGENCY HAS STATE OFFICE OF -ME iENGY SERVICE ORLOCAL Jf, �NCY USS ONLY <br /> REPORT BEEN FILEU 7 ❑YES E!T,-NO REP4RIED 191S 1I.MATiON�� OFF1C1Al S PURSUAI� S1 CTtON 2580 T <br /> ❑YES 0&AFTY <br /> CASE I <br /> REPORT DATE <br /> SIGH•{ TUBE <br /> p}iONE <br /> NAME OF INDIVIDUAL FILING PORT / to.I y- ►Y6 <br /> l `l I <br /> Ly- <br /> AR-t,10 t<tOo COMPANY OR AGENCY E <br /> ❑ REGIONAL BOARD <br /> g REPRESENTING E] PERATOR <br /> OWNERIO <br /> O �(pCALAGENCY ❑ OTHER n1 SL�6 <br /> 1 zea <br /> a <br /> ADD R S ,� <br /> STATE . <br /> .V jz,41 20 0 lsTaEEt PHONE <br /> CONTACT ^RSON <br /> u, NAME ❑UNKNOWN <br /> STATE P r <br /> y a ADDRESS �- �cmr/ PHONE <br /> U wSTREET OPERATOR <br /> 7� <br /> FACILITYNAnME(IF APPLICABLE) <br /> s <br /> Gam' j�'1�r S.�Cv. :,iZZ <br /> Sf � <br /> 4 ADDRESS �".'/�J <br /> O 30 Lv r ( `� JEET - CfTr <br /> lJ <br /> INDUSTRIAL RURAL TYPE OF BUSINESS ETAIL FUEL STATION <br /> I TYPE OF AREA COMMERCIAL❑ ❑ FARM 7HER <br /> H CROSSSTRfET ❑RESiDEN-AL ❑OTHER <br /> PHONE <br /> Ir�"v``r AGENCY NAME CONTACT PERSON <br /> LOCAL AGENCY c 6.C4 - ! <br /> PHONE <br /> REGIONAL BOARD I <br /> I QUANT[1YLOS7{GALLONS . <br /> NAME !/ UNKNOWN <br /> � � ❑ UNKNOWN <br /> (2) <br /> ❑ SUBSURFACE MONITORING ❑ NUISANCE 00NOiTIONS <br /> �- DATEOISC'.OVERED HOW DISCOVERED ❑ INVENTORYCOIfiROL y <br /> iii �•1 ' p ❑ TANK TEST TANK REMOVAL ❑ OTHER <br /> M M ° ° r r METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> DATE DISCHARGE BEGAN ❑ REMOVE CONTENTS ❑ REPLACE TANK +=� OSE TANK <br /> a w ;rUNKNOWN CHANGE PROCEDURE <br /> REPAIR <br /> M <br /> REPAIRTANK ❑ , <br /> >Q HAS DISCHARGE BEEN STOPPED 7 <br /> O YES ❑ NO IFYES�.DATE ' M p �o �y y ❑ OTHER <br /> MATERIAL CAUSE(S)SOURCE OF DISCHARGE 1 TANKS ONLY CAPACITY gUPTURE1FAp URE <br /> � TU (w- ❑ FISERIS ❑ OVERF0.L ❑Q/ <br /> ❑ TANK LEAK t� JNKNOWN <br /> YRS ,STEEL ❑ CORROSION UNKNOWN <br /> ❑ PIPING LEAK AGE UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br /> ❑ OTHER II H <br /> Lu CHECK ONE ONLY <br /> vF-1 UNDETERMINED SOIL ONLY E] GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE 0NLY � PLETED OR UNNECESSARY) <br /> ❑ SITE INVESTIGATION IN PROGRESS{DEFINMe EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRES E <br /> m ❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORWG IN PROGRESS ❑ NO FUNDS AVAII AB TO <br /> fVALU NG CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTIONS)(SEE BACK FOR DETAILS) . I <br /> REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION O) <br /> ❑ CAP SITE(CD) �` ❑ EXCAVATE S DISPOSE{ED} ❑ REM { REPLACE SUPPLY(RS) <br /> I EXCAVATE 6 TREAT(ETI ❑ PUMP 6 TREAT GROUNDWATER(GT) ❑ <br /> CONTAINMENT BARRIER(CB) ❑ <br /> ❑ NO ACTION REQUIRED(NA) ❑ OTHER(I � <br /> ED TREATMENT AT HOOKUP(HU) ❑ <br /> � <br /> ,� HSC OS(1.97) <br />