COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Notification of HazardousWaste Site Side Two Waste Quantity: Facility Type otal Facility Waste Amount Place an X in the appropriate boxes to t. O Piles G.c fear UNKNOWN indicate the facility types found at the site. 2 O Land Treatment In the "total facility waste amount'" space 3. a Landfill gaiions N.A. give the estimated combined quantity q, p Tanks (volume) of hazardous wastes at the site Total Facility Area using cubic feet or gallons. 5. O Impoundment 6. O Underground Injectionsquor, loos In the "total facility area" space, give the 9 estimated area size which the facilities 7. ❑ Drums, Above Ground acres <5 occupy using square feet or acres. B, ❑ Drums, Below Ground 9. O Other (Specify) Known, Suspected or Likely Releases to the Environment: Place an X in the appropriate boxes to indicate any known, suspected, ❑ Known O Suspected J& Likely ,DNor, or likely releases of wastes to the environment. Note: Items Hand 1 are optional. Completing these items will assist EPA and State and local governments to locating and assussing hazardous waste sites. Although completing the items is not required, you are eneouragad to do so. Sketch Map of Site Location: (Optional) Sketch a map showing streets, highways, routes or other prominent landmarks near the site. Place an X on the map to indicate the site location. Draw an arrow showing the direction north. You may substitute a publishing map showing the site location. Description of Site: (Optional) Describe the history and present conditions of the site. Give directions to the site and describe any nearby wells, springs, lakes, or housing. Include such information as how waste was disposed and where the waste came from. Provide any other information or comments which may help describe the site conditions. J Signature and Title: The person or authorized representative Nam, W. D. Williams, S . S . S. Coordinator (such as plant managers, superintendents, 42�Ownef, Prusunt trustees or attorneys) of persons required to notify must sign the form and provide a sire,, P. O. BOX 2240 C Owner, Past mailing address (if different than address G Transporter in item A). For other persons providing c,y WOODLAND CA 95695 0 Operator, Prusun notification, the signature is optional. smia Ly CoJu ❑ Opurator, Past Check the boxes which best describe the O Other relationship to the site of the person r/�� required to notify. If you are not required Signatureyl\(A. � !^ 0 5/27/81 to notify check "Other".