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<br />° � rF4l tliC; If`IRiS
<br />r L y
<br />i- �i�ic.N-
<br />., 'wheuhcr-t€"�f:rgeny re-sponse p,.rsonnel at}£f f'ClU"p3Kry were 1" 'nd at t
<br />;rt#?C ,,. -��£'' C<t'Lgory which best, describes the current StatSS of the case.
<br />any ii".f 5C, a Hazardo";S "`aterial in iddn R £}rt sM ld he filed With
<br />CMck one box only. Me response 8hauld be relative to Me Case type. l'f}Y
<br />the State ^f�fim Of Erewle:ncy Services (O Si A 280 treadmv€ew Road,
<br />exaWeAwase gyve is "Gromd Water`% then "Current Stats" sh uld refer to
<br />$c'.Crz}€ne3:.tC, :`.,A 1... t3;1�« �;Gj:ies�i)f i}F .. r"C[70 rt for€R be Gb tai?leil at y01€r ,
<br />9% rho Z may
<br />Me Status of the .rood water investigation or Cleanup, as oposed to that of
<br />:s
<br />local urdergr°eitand storage t"k pfrntittingi'rt",+a,)F,) a;aer?:y, ln£ii_:a€:e whether the } S
<br />sail.
<br />report has bwn Bled as of the date €}f this report.
<br />I; '��� i�G�.THIS FORM .; ?.`€`Nuri: }OR u'E'NL€tA€.
<br />, :liftOR':ANt-:7Rf•�rtT t;?N
<br />Es C L AGEKY Gay
<br />STATS` 1CAL PURPOSES NLY AN aS NOT 'G BE CONSTRUED AS REPRE RNTI G THE
<br />notificatiop pursuant to Health and Safe:"y Cade Section
<br />OFFICIAL P€3 IT,..x OP ANY GOVERNMENTAL AGENCY
<br />Z11807, a designated governm.pt �inployee should Sign and doe the form in
<br />t? is E17rck: A signature herr not that the leak has been deterninee
<br />REMIEDI yt ACI =N
<br />...-wFi
<br />.rean
<br />to pose a Signifit?rt threat to 7€T'. h;aith or safety, only that notificat€`Ji?
<br />n ac ions have been resit{ to £lead€:L' or rcme'diate the leak.
<br />procedures have been followed if req-z.red.
<br />Des""Mons of OHMS follow:
<br />REr Ytl(YED BY -..
<br />Cm Site - install horizontal Awermable layer to reduce rainfall
<br />Cr e YA name telephone nun€ben and addwss. Indicate which party you
<br />fRiitr'ation.
<br />represent apo provide. company or agency nairfee.
<br />Containment Barrier _ instAl Yenical dike to block horizontal aavement
<br />67 E:76tdi`7i li lilt.
<br />RESPONSIBLE PARTY
<br />Excavate ln£1 DispoSk - re..4ove CGnta€Ri r.at'ed Sail and disp w in _?jii?towu
<br />P.
<br />t.niNr f'ptiarF: 4€E€'i`Sr+" contact person, and ddEtrf?SS of the party
<br />Sl ff•.
<br />r"FSponsible for the Ink. Me re nors.ble party would normally be the tank
<br />juavve and Tr"t - remove contai! meed sW1 and treat (includes
<br />s^'"ea<!ing ar° anti faming),
<br />owner,
<br />Re€nove Free Product - re€,'eve floatinfx product froEn water
<br />STT OC1T N
<br />'f T6)77
<br />*.i'rzr Yn U nl,tit>n lana€inrl tors fn_ _ g
<br />faE:il f and 4:J r'r'Ctl f4in nine's.t a
<br />D€€(l to T Cat ,.roandwatrr _ ,generally e<?ployead to r�>€mve dissolves
<br />..}�_.. ..... —
<br />'S€?il#t`fUrJi, you €??L€St Provide dt? t(,x f�z;: 7?yi` n""f'.f '?.i `. �..1€ i?ddr"55. ...
<br />t'0€?fi dtfl €tr fs
<br />- _ _
<br />Enhanw "t M£t;EV--'iui£)n -• USf" of my available technology to pro''notf;
<br />IEr3, MEW rix AGEK tS
<br />bat .r al J< £rliUS?t n of eont3inan, .
<br />E:n.rr . <}aE , o. thE, i.}cel . gen) ad '.e^An"hvfattr Gulrt*..q Contr£}7 &}and
<br />rirpiuE,e SupplyW - provide alternative water suCi;)iY to aff'ecE!
<br />iia Dived,
<br />vlrt"CS
<br />- _
<br />T r'sl-mont at -.€okup".i ." ins= water treatR}ent devices at each dwelling or
<br />Sr€ M CS T r{l :E l'
<br />o ff_r tie 7 i€ E?.
<br />__ ?rn _
<br />}l,., '€ d 'U'st of the ?'12,,a+'Et.C,tFJs involved. 1laGtn 1,5 _-
<br />n
<br />No z :t n f: .. C337. .d •- Vin£:if'i±"'nt. 3S minor, '="L'Cl£7'?"'i €'.ij no
<br />prnOcrf.E' .£}r inf€)wation on 'wo substan,..r; it Win] 3priit£, if fix)re. than two
<br />:..t:''(,F Wflon>
<br />$€if Stanc'rs .€.?dated, i?" the two of most ..#...i-n for c E'e;mp. ,
<br />'-'.t?°7M=.i9?S Use this SpaC:e to f?lab{; r.:•tL' E}t1 ai1Y hum" of thE.' A;iC,'d£?ni..
<br />i
<br />r` GrvnY l� i M P
<br />S hiFTxL S c,'€ the o r in the Space provided.
<br />Priu E€{ n , s t,tr regarding the .7 scovery aria: taoei of the= 'rak.
<br />bb ,
<br />OUREC fAHE
<br />If the f£}rif £r €ornpf, ..by ch£b tank ow r or his ii ent, re tahn last copy
<br />indi_ }t.. h,ce(s) of Met. Pr"Gvme deui's an tank :p; Cavity acid
<br />and hrwa. Ef trie rn€iaining copies in tut; .£1 your 1wal tank ,t}erCllt; ,, M agency
<br />Ric€aerial if know?. Check box(4s) indicatinf,£;i}Us G' Cf leak
<br />'for Ci5'trihUC on.
<br />Or-igiml LnM Tack Per€nttti" Agency
<br />CAS? rNE
<br />L State Water Resurces Control (bard, Mvision of Water Qualit,v,
<br />�__nd sae fht # a tate cat< o y for, *his In k— Check on x only. case typo
<br />UnaeraeEund ark Progran, P. 0. Box 700, Sacramento, CA �58Ol
<br />is bm d or the Yard sensitive resource affuteck For example. €f both soil
<br />.I Regional stater zQuality Cortrnl c.r
<br />and and wa.,:xr he Own a r,.:t£,il, case type wi I! be- "Grourd `.pater
<br />4County `loar-` of S€lvervisors or designee to rmehe Proposition 65
<br />Sr
<br />x€"i'i 'tf' "UrbAing M'& only if .Jii�. of, n€t,rf' Municipal or d oi..eS t W-1t:'Y'
<br />notif" } )iM.
<br />=wells `"e aEAually b"n affe t:C A arCli,_d Water" desipdVen dw; not
<br />party.
<br />hear that ne ,;; fee d water cannot be, or in not, used for dnnblrg water,
<br />bi€t only that wo,er wells have not, yet b"n affecter- It is undernood ria,
<br />Case type €say Chang;, upon further investigation.
<br />
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