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INS RIJI mION
<br />SMERGENCY
<br />L.cak.Ee n CinLfilLmcd Leak suspected at silo, but has net been confirmed,
<br />Indicate wleeti?ex° emergency response pe>_:xo:ansl and :?q..ip=nezzt were ir?vaa'veci
<br />1'seiam��a��;Site A>se stser:v Wo-kr3.la: .unr.iUi:c°d - vres kY;a..an;prapcsa'
<br />Y%w c"aTFy. ti e, .�: SCS;: £§. Z :Cf:CttSMaterial i_.0 t.. C'.Z. ir?j„3Pt 590'.:.�:.C: s2 it ,..'?d
<br />', S4'q11e..ated of/s ,a7mittsd by . 2'4?SpCJ..sible par'. -y to determine whether „ground
<br />with the atete -office of Emergency Services (OES) a° 2800 Me:adoa,r icn Read,
<br />water blas been, or will be, impacted as a result' of the rela<.se.
<br />Sporamento',"C A. :5832". >.oDies al the OES,reporUl .' foriri,may be �Ctbt;iiined at
<br />j're:.,,,T:inary Site _Assessment TUndert,7a - implementation of woxrkplan
<br />your localux.der,round storage tank perm tri. g age:cy, indicate whether
<br />Pollution Characte'rizat?on - res;ynt2'sible pa..ty is Tn t`.^.e process of f�ul:y
<br />the Ot,S v,k.:L3.°'1 s1rx,. .re _.,. all??d as of the ;X3t.G of this report',
<br />'.'defaaxi.rg wH,? extent Cs. Ci77,.ta;Ti1Z1<%w1t13`x in S't1i and iground water and F39a^5z.,.,.7,zb
<br />Tpacts on surfac and/or ground tante;-.
<br />LOCAL AGENCY ON Y
<br />R nea%a .dn z'l.an -"remed4 at.on plan st- mi.Ated evaina :g long :term '
<br />To avoid duplicate notification pursuant to Health and Safety code Section
<br />ered atict. on ti ns. Proposal anO Implementation schodule for.appropriate
<br />251110<51 a gnverT est errloyee should sin and de -,e the form in this block,
<br />re.meallatiot options also subrr tt.od:
<br />A signature her=e does, riot mean thatthe 1cTk has been determined ?e rosea
<br />Cie =ctr' L�eruav - 12>leiil °ltation`cf rcred9at en plexi,
<br />ca ,y , or— that <2t7'F,,1a. x.Cat?, Q:i
<br />significant threat to human health -or �e "y f
<br />Pyr.>:: :%£: iiT?ti `�CrTI Y. t,3r .?.1 "' iT1. �„, l . EaS �"" periodic ?'il..4":'7C� water _ J.":..O�.:teZ
<br />p g.
<br />p:41CaCitXr e:B have S.3ersTi ollowed it r Ca _e
<br />{<?iLilTg Lsite, as necessary, to .e,Zi.fy and/or evaluate ef.fectiveness
<br />of remedial activities.
<br />RhPOPTED BY
<br />Case Closed -regional- board and ace a�&en_^y In concurrence that,. n;a
<br />.Enter Your n-_Ime, telep.hfs?.e,nit;i3ber," and adia ,es>s. Indicate which parvi .'y=_u
<br />,ftlit,hk'..`. work is nccesza y at the sits,
<br />,gWpresent and provide company or agency n'=e,:
<br />IMPORTANT:
<br />OI Aria:` THE INF+Ozi.MATIGN PROVIDED ON THIS PLDV.d IS INTENDED FOR c NER_U
<br />ESPC)NSli3LE l R'1'Y
<br />STATIS_ICAL z..RPOS S ONLY ANI) IS NOT TO aF CONS iUED AS REPRESENTING E
<br />1' ItP3: name, "te?ephone number, contact 'parson, and'addreas of the party
<br />0FFICIAL POSITION OF ANY 'GOVERNMENTAL AGENCY
<br />responsible for the lea, The responsible party, would normally be the flank
<br />owner,RxWt-1E
<br />ACTION '
<br />Indicate which action have been used to cleanup or re.nedxate 'ne leak,
<br />SITE LOCATION
<br />Desrriptions,of options follow:
<br />Enter information regarding the tank faoili y, A a miniivum, you ;rust,
<br />provide the facilityname and X1211. address,
<br />Carl Site install l ;icorizonta impermeable I. F''.;C to ,K'e,d ice ru^"7.RI<tl.I
<br />p• );'
<br />T7, _ t,rabion.
<br />IMP?EP;ENzING AGENCIES
<br />io..tain r.it; rair_..r install vexti.c<.l dike to block horizontal mcvemexa= of:
<br />local agency and Regional W.at} (70ntroi Board
<br />e.atQua.
<br />Enter it £3173P.S rr t. ..?1e � Lk ...
<br />contaminant.
<br />i nvoll, ed.
<br />Ee Ca%ate. cino D->: Oce, remove ccontlr.__ atetl soil and dispose in app.-oved
<br />SIT e,
<br />SUBSTANCES !N-V^aL�,-ED`..
<br />eavato 'fY.fa` '` eat - .rcmove ct2ntaniinatE? soil, end treat (includesSY.±S.'G<.,
<br />T
<br />Enter the name and a iant,1-Uy ''lost, of the hazardous substance i?i'v..lvcd. Roca a1
<br />or land fa_mins) ,
<br />is provided for information an two,, subs,;ances i?: pp rc,. .rx.'iate. if fi7Cr4 than
<br />Remove Free Product '. rE'movo ¢l.oat_:_•^CiLs ,
<br />water abl
<br />.ng pct from table -
<br />q.
<br />two
<br />. two substances leaked, lis., the two of most concern for.�.
<br />Canl° pl
<br />i'="i3:". ..,.3: .rte';.�.; .i': C3 Lt?'!r?YZc1 i::C5" generally eilphoyeid to remove ;i"LJed
<br />s C;
<br />c enc.a, minantw..
<br />ilISMVERVA?lAT .MEN'r
<br />n1s F,::w a<_° icTa - <,i e of atey i£tb_. tc iT'aolcrgy to x T O„c f .e
<br />e .. ..,. _.__.
<br />n C
<br />Provide _n.olm, atioa . es aZdi; t_e _scove:ry arc? ,ala .'.._az of the, Ieak
<br />�.
<br />.�::cteri.1” dovoc1,rrocxn a or c:o_.t<..,_:_natit;.
<br />:_«c _ y pxcvido alternative water supply to affected p_;_..:es.
<br />SOURCE/CAUSE
<br />z >.1
<br />. ea-,meT t _Uok?i� - install water .,weT:d,irant, c,exrlces at each dwelling or
<br />Indicate sourc_,cs) of leek, Check box(es) indi.a,:ting cause .+3'. leak
<br />J i pl c 'of-use
<br />Va t -ae Extract use slurps or bi we: draw air through soil,
<br />Y e 13(3X., holes in soil to al low v-lati`ization of oont-.am_na.., s,
<br />Indicate to caez:e type cetegory-icor this leak, TW_,::ck one boy," only, Case
<br />N Ao. Ton'te,r'.:rire: " in,_Jden: iz Y€in,,').r, requiA.1n<& It) reme:'.lal action
<br />type vs ba—ed on the most sensitive .resource, _effcce .,d. For
<br />both s:a_1 and ground +awe;: have been af�fen, e,-1, Warr type- wil .: be "G:ound
<br />C"'V, N 'S - Ilse this iwpac� to elaborate, on any aspects of the _,zczadeiht ,
<br />Water"..,dtate : `°
<br />„ L x.a:Fg mater" an. y if one or more municioaL or
<br />domesti 4 water wells have actual y beer affectee, A "Ground 'nater"7
<br />:?v"r. MRE - Sign the forst in the s race p o i-ci d.
<br />designation cb)es notiiap3_y that: the a ffc tell w i ter .,annot be.3. :Sir IF, no, t,,
<br />:.
<br />_ """"""'
<br />.
<br />used for drinl-ing water,. but only "1iu ,ssf% tolls i%VE not 'av been
<br />tiqT {T T;„(v
<br />ed. It . understood thatcase, type may ah<.g= npat further
<br />er._I-a agat zta_n ie st ,opyaftve
<br />°eL£of d by he aicm-i
<br />int .. ; a .W r .
<br />and forward the _e'mai?i.ing copies iniac" to yo,cir local tank a ercl_i c.__.g agency -
<br />CURRENT' STATr
<br />1. Crig nas .,anal T..__1 i errnitti ng = gsr f Y
<br />Itl.i-,.%ells,, the`. ft.s,_o,.y wiit,.h vee, de.,r oo., ,_11.> i.i....nt ,t,atus of he coag.
<br />2, l lt<x..._ 3{:ao ces £"o:T ro" Board, Division f C_ea. later Px' 1,
<br />Cherk one loos; `Jfa�y. h. :-e-noose, <>r_._,ld'u :i a,,r.. tr the case type, =`rw
<br />C,_.:�:.rgro.xr_,, Storage `lank Program, 11. 0, � ,4 212, ._.us .„ 9 244-
<br />_xafti.le. If czioc pyre Is "Gxoe.ali: ra, ue:z '. ''..:_h _. Stat, z1.ould
<br />Iii=
<br />.._ . , s '_Cote.
<br />(�the _tsL3 s,.Q Tcz�d _taz.,wan . as ,k
<br />i E _4' w,a �iQuality Board
<br />tha.,. oll Descriptions z :. :., s) •a -L_5... L:3 .. _<-%:; �
<br />4 Local 'H'Aa, .Y_ tatfil.,e3' end :,_s.It 15oa ,t of:..up .isora> , or
<br />No Ac ".. :'_: `. ., c.i.`-. ,.., _. ,.,x,..T; "_ul..G+ pf Z. `-T ,,3Y ...:ef
<br />.. �_.i It :-1 ..� ,...c t ,. :_
<br />w. 3 i..._A ,_�" .£._,, :: ,. i. .,. ,^a._'ty
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