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dLeak Sli5p8(:t8d <1L Site, i'.J,it ...^. =)L: '13 U'?£Ya n ,;Ei£ateti.
<br />ir ica`e whe he.-^i'a„a<'ger---y response Personne, and ei1T�4ijM9nt, 'were ii`vOl d
<br />q
<br />PrIliCiala''' Site 4s-Ssitent Work -plan Sine .4.�;teff
<br />_
<br />3t. any time, Ian". ,.¢So 1a':; azardous Material lYiG 1'i i::7f, Rw$%Ort sh:��xld be �.l d3A
<br />£E'ij?.%e�t�d „L L?sUbStl�i.t:ed by r sponsible I3a_,ty `.:3 ei.Bt??,
<br />.., n�iaet,tie£ gr6' .-,nd', �
<br />•.
<br />with the State =�fficc of Emergency Services (OES; at 2800 Me:adown it ewi Roan,
<br />water "has "o'en, p -r will be, .. impacted a a recult o.
<br />V.
<br />._-eleazt"?
<br />Sacramento, CA ?5Sxt. 11 ,les of t€:e OTS reptf , form sway bre czta�nad at
<br />P.l3elic anazy Satef . e went Ul.c:ernaY mp gimes, at ....
<br />workplan.
<br />.z
<br />Fes.,.-,.. Y ,.., y
<br />Your iccal .n.'�.iet ro si st of e 3aiii sei vt i Y eT cy, And4c< 'Nhe seer
<br />f L
<br />"ollu , .rl ,Aist atteria._` ion resz.ons .i.7.. pa�
<br />.$ q.'Kp
<br />c H Ei.1 �
<br />;e I .t report has b7 ! e I as pf tbo date 'vi this, ?e;Mort. _
<br />aeiiring the extent of contasbriat.on iii soil and
<br />water and alae. _
<br />3
<br />i .SRa (: Q. a
<br />"3act,z on surface and/or ground water.
<br />'
<br />LOCAL AGENCY s %IB;v'
<br />Remedi at on 'Man - remediation plan submitted e elua.:
<br />long term
<br />'
<br />eo a Did .1C;.pl'--.ee .,, .,Zi' :.a:ati.on` purs`zai?i, to Health anq��d, Safety co;a;%' Section
<br />remediation options.: Proposal and imp_.emer...aticn .,,,
<br />...... ,za fG2 d}.;J3 .'..te,".1x'?.E?
<br />25180, 5, a g over`.nbT erMloyee si?tuld s;gn arxii date ^i'��e form: i his "b,.o-*
<br />remediat_on,o'tions also submitted,
<br />signature re hese fd n in an tit the leak has b•rezi dBt YTti2'Eed to i ase a ..,•
<br />C Pan o Underway - implementati-on, of sem axat Uu „
<br />g;sllfica,'lt tLi%`E*a.L .., :.:..:,,2P. n�s:t C£ sa .et''�,„{Jn only t:1 x'1t .l i?'..Ca'$»=i •,oS: ��
<br />PCi �i'G.. ".�.i'Ei?2tia L�Qii7.%LAii.:7 '-n �?^O r£¢ �, ".il�dr�.CE.ii::- gt.l -�.':
<br />', .'C, r', i” i�1 L: �,i'; t'?9"
<br />procedures have bee-lonied ilii, equine^.. t,' Y ;'
<br />ncnitrrirlL site, as necessary, to ver a lrflr. ,,.
<br />ate e�fec �xe:ies�s
<br />a
<br />of remedial. activities.
<br />"s
<br />Z
<br />REPORTED B1 "...
<br />Case Closed regional board and local agency it c.,.>:,:_,_,.xt,c,,
<br />that
<br />Enter your name, ,'t 1ep7��aa;e number,, and addresyY",, Szzdic t which p<?ty ytas`
<br />- further work is necessary at the ite_
<br />p
<br />ej'S.r esen't and i3r :r....i.: iavG%inp.any
<br />i'
<br />$
<br />,arname,
<br />„. -IMPORTANT:
<br />R4:SP PARTY- ��
<br />THE INFORMATION PROVIDED ON THIS FORM IS N
<br />„e STATISTICAL PURPOSES_ON, X AND IS NOT TO BE CiN,�.R:J::ii AS
<br />F6R A?
<br />i C,.iLNTLxa z!:
<br />Enter Win , telephonentalber, contact person, 'and addrei gf the party
<br />OFFICIAL POSIT GOVERN TAL, AGENCY
<br />respo 5iVle for-uh-e Ices, The retpons"ible paz-ty would no-paal'ly be the ta=lk
<br />owner. ° i
<br />A
<br />R M DIAL ACTION
<br />,
<br />r a
<br />Indicate which action have been used to cleanups or -cmo. -,
<br />xi ,;= the leak,sq
<br />SITE LOCATION d V
<br />Descriptions of optione follow:
<br />�
<br />ETItei information regarding Lhe .tank 1i cx its..:: At a minimum you
<br />provide the facility i ame and 4uil adA.;ss, '
<br />Can Si e - 'nstall horizontal impermeable layer to,
<br />inf*a*
<br />�
<br />infiltration
<br />� r „
<br />„
<br />IMPLEM' ,`TING AGENCIES"> _
<br />Contac Lment Barrier - install vertical dike tobloc^
<br />__zsxti.ai rasy�a lir ci.��
<br />'rL.:.Er i:3;ReS of Lt19 ,..J C,aI a bR:cnal 41 tL" Qtiy�C .trfll _Dar
<br />.-
<br />contaminant
<br />_
<br />r
<br />involved, ;"
<br />L_ cay, e aind Dis . oae - remove can..taminate 1 so— end
<br />s, ill i,,reve a
<br />.,
<br />�
<br />site
<br />a
<br />.,i xz _ NCES INVOLVE
<br />f7cayit. _ and Treat, remove contaminated soil and tr.,
<br />{ ,.,1Q ; i,: S ... E�>.y as di _
<br />..G,.
<br />Ent�,-z L.., iir�£C: a.'f'ad L -T fi ,.,'y, h{:3s' of til C# i:a2.a r`{it„ti5 .5 t.ab $ar.c 3.avo;..;IBL" ,�R£7GEii
<br />or ..atn., farming),
<br />}
<br />.,
<br />is provided (; •,•
<br />lost '.nforz:i tion, ZS tiF¢ sUi35tanC es 'fit aPpro riate. If more t2k .Ii
<br />�'eR1L1VG' �r Be Product ,.£emove f .gating produYct from 4:,'_
<br />.•
<br />li"e
<br />,.c•"�
<br />tY*7C3 substances 1.ea: F:x-,' ist t "-e '"., fl of CO G@'^n fes' "' Fr'lEiLi '
<br />-� rips` `" `. p.
<br />r�tjmp a_ d Treat (srt3Undwa Ler - generally employed '.��' to ` ..
<br />y P y
<br />�
<br />saJ v Ad_ {
<br />,� w
<br />`
<br />contaminants
<br />4 r^
<br />"
<br />DISCOVERY ABA` EM nem ' .m � �
<br />Enhanced H.ioa_ £ada* r�€ - use of any available e ewi.i<'
<br />p "'T te'
<br />a
<br />Provide infol-mt_tion girding the disc very sox abater Sent= of the leapt', ;
<br />€i:
<br />bacterial docompositigxi of contaminants, -
<br />-
<br />l�,-
<br />R.e La e Supply - prCv.2[de al.tert_ati e water tf r 8 �
<br />.. f -` i 3Y't-Up's t
<br />`
<br />:SOU N i'' `. - .,�. 3
<br />o Treautment at iiQOkU �`anstall water ..Ha:.C'icTnt �.LC :�`.
<br />_., f. R.
<br />Indicate source(s) of -eak.= Sheck box(e , indican n� cat e' of leak,
<br />other ?lace of use, ..
<br />�.
<br />7 .i2 •i' act` USC PU''apS Or blowers to d d?t. 'alt T ::
<br />S6�A.I.�
<br />"?
<br />CASE TYPP,'. .'- > F
<br />V nL�[SOTLt- }lore raC}I.es+: in soil t0 allow JC2 .,nl.izat ...
<br />OiF"�-a Yds.aaizt,s
<br />"s
<br />Indicate the case type category for this le Check Check one b6s: only, 'as'o .
<br />Lxo Actioo R,6ouired - incident is minor, ri ,:ir-an z;_is
<br />ion.a, tr§
<br />type is based on the, -mo ssi.tIve resoilece affec:,ed-- For. ei apie, i
<br />s,
<br />m
<br />both _,
<br />yl and g£vun ez haye Nem°2 affe lea; casBi,tAe will be "i;E.o.xnd�R
<br />COtC�ENTf, Use this space to elaborate on any ai ects o
<br />zzezeie L, A ^
<br />Wate Indicate laking �,ate4" only if ofz4ior nate rn aYir.iPa or
<br />domestic water wells have ac xal y been affepted. A ' round Water"
<br />SIGNATURE q- Sign the farm In the space provided,
<br />iesagr.4=.Llan does not mply that `1 -he affected w,�ter cannot, -=be, cr is Ile, -
<br />4 f
<br />used for drinking ana.,gi,, but once* -hat wate.-lgells have not yet been
<br />DIS TRIB€ITTON
<br />r i
<br />affected. It is unrlers cod ehat tpase type may' change uposit further
<br />If the form js completed by ehe tank Darier e£ i is agent,
<br />=lin r„he ast capyi
<br />investigation.. ri,`
<br />and forwaEr,ti file relY2ainin�. 'copies iY:i.acy to _y0ilr local ,., 3LniS
<br />>rri;.��;t;a�g :?g,��iECy u� �'s�,,,,, .•
<br />-
<br />„-..,Eil.>tri°butit3n.
<br />-
<br />"a
<br />CURRENT STATUS
<br />�
<br />3. Ox igxzal - Local. T nk `Palms *,;.,za Agency
<br />_ndic<ate the categ,ar_r wbion best',describes the current statlus of the case.
<br />' ` 2. State datax Kesources. ontro:. Hoard, Division of t ua,,;
<br />.� p� i og,-a z ,
<br />Check one box only. .pie respmnseash uld'ibe r&`Lstivn -fes the case type, 9or
<br />�Undei 7 ound Storage Tauk: Program, P.O.. Bo.. 9442_2,
<br />.tu, 94?44-
<br />ex :mo a, if case type i s 'Ground 6'at r” thej ,"Current Status a'.zouId refer
<br />2420 s
<br />to the status of the g&,snd wate'h^ inves-:�ation or n_3 aai up s, as opposed to
<br />git61 aI Water -Qualit7 Control Board 4
<br />�
<br />that of ,soil, Descrip zis of o pions _olle •7
<br />4�: Lo�sa IieaLUT t�Fficer and bounty Board ef. ` upe�:.v._>, x _
<br />�;c e,,i,.r"' &zCn e w to'
<br />j
<br />-cce4l a. raposi:tiozz .5 rot§_.facations.
<br />o Action Waken Po action `E�� been fake ,3by reslfLnzilble party beyond
<br />5. O', :r -OF abl.? parte.
<br />�( _
<br />.,
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