Laserfiche WebLink
UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE{LEAK)!CONTAMINATION SITE REPORT <br /> EJAERGENCY lIA,S <br /> STAN OF!ICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> REPORT BEENFLCD T <br /> 4 CD VEe RL yes No I HEREDY CERT Y IMAT 1 AN A DESK?NATED OOYE NmINT FMPLOTEE AND THAT T NAVE <br /> REPORTOATIE RFFCRIED f WORMATK TO OCAL OFFICIALS P WS�►ANT TO SECTIM 2sa07 OF <br /> GSC I THE p <br /> 01 Ir r} r / � f <br /> NALIE QF INLIIVIDUAI FLING REPORT T <br /> PHONE L <br /> IGAIATiIREP BENT - <br /> ❑ OWhERIDPERATOR ❑ RE01DNAl80ARD L�DMPNfYORAQENCYkAYE <br /> AGEW.Y ❑ OIMEIi r / <br /> AWRESS <br /> hTY I ; <br /> NAME ��7d <br /> [193 p <br /> CCN rAtlCiyP/F,R�SON I ; yf/ PHONEr <br /> ADt4 Ss ` UNKNOWNr ��TiGt c /Ill- '54.e ._.._.. 0)71 7 O�7�pCJ <br /> TWIT <br /> FACLITY NALAE If APPLXU&E) � CRr � 77a�T 4� • <br /> DP$RATOR PK)NE <br /> CROSS STREET <br /> � <br /> ET <br /> AREA CDCOM4WAM❑DMSTAYWI RAL IYPE OF BUSINES! ❑RE FAIL CUfL 87ATlgh <br /> ❑RESDCNraAi ❑oTI+sR �. }- I]FARM f"„r. ;k <br /> Q LOCAL AGENCY AGENCY NAYS CONTACTP`RSOH PHONE <br /> it t__ _ <br /> REGOOL SOAM0 -- — ¢lam: ._� <br /> CY�v,QCl3 ,{ 2— <br /> PHONE <br /> -1 G✓-S�uu <br /> }} M414 � QUANT"LOST cr kuwm <br /> ❑ ulaAawN <br /> 61IE0WG01TcRED Howo9iCOYERED WYE ❑ <br /> 5 3 ❑ �,. ❑ ACE MCNiTORY`CI <br /> Nu�SANCE nONNTIONS <br /> TANCTEST AMCTiEi10StK L'1 OrrIER : _ <br /> DATE DMCHAROE BEGAN 70AErmOvE <br /> EOTOSTCPO0^G+ARCIt(C &LT►LAfAr,0Ln��� <br /> NAS ul r BEEti STOPPED i apwN CANT I+}TS E J RFPLACETANK F,- "LOSE TunsREPAIR TANK ��� AEPA;R PrWO FJ r: -PNOCCDUAE <br /> YEa ❑ NO IFYMOATE ❑ <br /> SOURIXOFo*cHA.RE i TA�KSON'LYC_�AC�+TY ,TRS MATERIL ~GA�t_' <br /> TAW & 'WQCW � ❑ FIBAGLMS /j$C-J1 UVER'riiF0�L5LKk�1 �Lw!lt•-WRL�PtNTUD%ri:WN <br /> AtufE <br /> PIPMLFAAG ML ❑ <br /> OTHER <br /> _ <br /> ico: .. <br /> l COMM ❑ GTl$A_` ❑ SP4i LD OTIiEA __ <br /> CHECX ONE ONLY <br /> 29 <br /> UNDETEWMEO I� SOL ONLY ❑ GROI??WATER ❑ DRMW WATER-PiECK ONLY F WATER WELLS IIAVE ACTUALLY BEEN AFFECTEDI <br /> CHECK ONE ONLY I� <br /> IKIIESTI Ann 11 PADGRE8a <br /> w ❑ (flEFaNlVLi EICTENT OF PROdLEt1I ❑ CIEANLP IFI PRDGREBS SiIGAIEOOFF IGtEANUP COMPLETED OR UWECESSAAYI <br /> NOAGTIONmix ❑ POSTGLEAmwuoWTORNGHPRxmw ❑ NOFW"AVALABLSTOPROCEEO C] EVAIUATIQCLrL~ALTERNATMS <br /> CHECK PFFt'Pr.IAIEACTDN(S}Me BACaKFORDETALS) I.1 !i <br /> ❑ CHIP SITE ECq ❑ EWAVATE&DaspoB@*% Cl REMOVE FREE M DUCT IFP} ❑ EWAWEO810 oEDRADATION(tT) <br /> ❑ CUNTA�iIENT RARRi$R LCB} ❑ EXCAVATE A TREAT O Ty ❑ PLAIP i TREA <br /> T OROWDWA7EIT ICI} ❑ REPLACE SLPPLY(RS) <br /> ❑ TREATMW fiT wD41GIP Rf,(} ❑ NO ACTION REDUIFED V94OTHER IOT} I--- ` <br /> e <br /> L-i... <br /> tlial[D._ / V icd-President., 1 GATE--3/31/89 <br /> .............. <br /> ............. ..»._ -- ....,...._....... . ....... <br /> KIle <br /> t rst errar--n , Irr►ir <br /> aNNalaasatlalatl slat tlitf•lltat441! lillalBalt{}�litlltalltsaltlaNataaltaalillatttaaltitatttassissas�tlsltslslist <br /> s�iEEK i � t06 DE I 11SI CODE AMOUNT DOE rim ml RCVD t K I ASN i lcvo D DAI A D � xlT a <br /> } <br /> 'I <br />