Laserfiche WebLink
- UNDERGR9ALMHORFZE©ftEtEASE fEEAKY/CONTAMINAMON SITE REPORT <br /> EMERGEICY HAS STATE OFFICE OF EMERGENCY SERVICES FOA LOCAL AGENCY tlSE ONLY <br /> REPORT BEEN FLED? <br /> C3 YESNQ ❑YES � 1HEHE9YCERTIFYT�tICfFHAVr=DI5�R1pUFEDTHISMffCi(i<IATIi]FTJ4f�COIiDING.TOTHE <br /> REPORT DATE A151R�(I[idN SH#O9IIOH TFIE15TRUCF)D115HEEF ON 7F4EY:K PA 'OF THiIS:FOAM <br /> CASEjj <br /> ODATE ?. <br /> NAME OF NONpUAL FLING REPORT PHONE SIGNATURE <br /> m L . (925 ) b4 - p.Agr <br /> REPRESENTING �OWNERIOPEAATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME F <br /> 13 LOCAL AwNCY ❑ OTHER C he f D r1 f'D G 5 CD Qfl <br /> ADDRESS <br /> box 100D4 San ?,grn0e7 CP` ati5f33 Ogog <br /> CBTATE np <br /> NAME rt1'� CCONTACT PERSON PHONE� h�v ron Proa�c�s Co. <br /> o ❑UNKNOWN e- n (q ) 5 <br /> o ADDRESS - <br /> . P• 0 , Di)X ( Obi-1 Sari mRTA"moo + C� 645$3-09oq <br /> FACILITY NAME SIF APPLiCABLq OPERATOR PHONE <br /> CV tvran Service S n # c�� -1 3f- c v s Com An f�.o9 ) 3 -a <br /> ADDRESS <br /> 3 3 _rroicY "Tcaey� San 1 as rn 953-+1p <br /> STPEU <br /> CROSS STREET HP <br /> wy 205 <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> SREaG MJLBa►Rnv)n �0vn} ��5 ARD �n Rewe c209 NI6 <br /> PHONE <br /> g Cenkjolt vcgkt RwQCb Mar-K L(s-} (qup )2 5 30 <br /> m (tl }} � `UNAME QUANTITY LOST(GALLONS)1%vi <br /> UNKNOWN <br /> a <br /> m <br /> ❑ UNKNOWN <br /> W GATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> O ;L p Q cl Y ❑ TANK TEST ❑ TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> ❑REMOVE CONTENTS ❑CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> a HAS DISCHARGE BEEN STOPPED 7 ❑REPAIR TANK ❑CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> 8 <br /> 8.1 YES U NO IF YES,DATE .L r ❑REPLACE TANK ER $e[ 0 fY M A A <br /> OF Of9t lAfi[GE CASM <br /> ❑ TANK LEAK ❑ UNKNOWN ❑ OVERFILL ❑ RUPTURSIFAILURE SPILL <br /> ❑ Prm LEAx ;E!rN <br /> OTHER ❑ CORROSION ❑ UNKNOWN ��❑ OTHER <br /> CHECK ONE ONLY <br /> ❑ LwwmRMNED ❑ 504,ONLY GROUNDWATER ❑ DRINKINGWATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED <br /> CHECK ONE ONLY <br /> ❑ NO ACTION TARN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERrIATKN1 <br /> ❑ LEAK BEND CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING N PROGRESS <br /> ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UNDERWAY <br /> CHECKAPPROPRIATE ACTIONM) EXCAVATE i DISPOSE <br /> Pwawx oA�� ❑ (ED) MOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(In <br /> ❑ CAP SITE(CQ ❑ E)OCAVATE A TREAT(ET) ❑ PUMP a TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> W ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED M ❑ TREATMENT AT HOOKUP(HaJ) ❑ VENT SO4.(VS) <br /> ❑ VACUUM EXTRACT(VE) OTHER(OT) C P <br /> W <br /> Se <br /> HBC C6(a" <br />