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<br /> 1 i Ld3Tii.i�rll3iti� ^ +
<br /> � Q C�Jr�ir,�}?'STATUS
<br /> dTtra_a1C{` .�= x r r
<br /> rrhe'Cheremrefewy r,sponsni92er5onSlarA e utipiraAr invclVedata_ {.nF1" ai: tie tatenflryw��irtb2st desCribEs the Current ;ta�u4 bfite Cis.. '7.':'
<br /> ely tree. If,�p.-a.Mazda dou, irate-^a�l Incident Prpqrt .shoal "&)filed with �0i one box cn€y ;The responsc,�shcu,lddbe relative tr'thgrf
<br /> i fYe ata rff�ice o` E-rlergency Serviwc (IFs at lG rleadnwj ew.Plead; } r�`a p1 if Case typo is "GrnanrS Water", then"'rrzrrgnt 5+otos"shouyld efgr, 5;
<br /> SafEr,,V,Rato, C;, p5 3 .--C,opi s of tfiUES report foini�may he �ltziired,a���0ur•7 � �f}se �tatus of the,graund water investigation or cleanup, as tppa ed'te tttat�f�
<br /> `, >�`'••�: snit. .. . E
<br /> erglorrtt�stor-a',,e tank pprmittimg agonov, 'ndic:atto}Wh�ther [he UES r
<br /> rWp.,t nos tleCrl ii2dlirf file datef i this repar7 ;;_, ` - r -f. , -INTENDED r]
<br /> 11' i�aP1F'TANF THE INFORM .'M PRULSFf1:D UR Tfil�'F�4Ei IS INT.NDED FOR:OIENKRA � re
<br /> f 6, ; .� ''I� 4 _�i ST74JTSTICAL PORPOSES UYfY A}7U IS rOVTU aF COHSTRJEO AS AEPRESENJIR6"TMF�
<br /> LOGAL TSE"Lc' w FL Y _
<br /> TCk2Vlt l rupli atm notrfiat'nn EtFrfsu r,t to Health,,a,r� Safety Luti� Section OFFICIAL �USITS �GF{A},y vCVER?sflEt1=?L A(EhlCY + y
<br /> a ler c1ra ad ga�ZarR€mPn1 crnpioyee s}ould s�arN- and date the farm sn. r , ;1rt
<br /> this rb.Cek. srg a2�re 4Ere d6es,not Ilean that! tfre :leak has " e, dL`erminPd R fLJ A' ACTION J^}
<br /> e! i nc? ca# a ace�ans have been usr=t'to.uleaVu or- erce4af'ate the ca ,
<br /> .t 5Se s ;S-r7r�e8rr� ih eat t�ur5 health or_safety. only tltaz not l'ICat}o ' 4 F
<br /> i `" (0escri tion of o f ..., follow: Y 7
<br /> prgr_e6res hrvp b.,,n followed if require=i. "� ?"� 4 R # p4 } Y k
<br /> Cap Sl e - ,L st"als hiwizont<1 to reduce rainf,l11
<br /> kP�CRTEiJ FlY iJ
<br /> ren ;r4 }ger narle, t'Iephona <iurehe'r,, and address ' Vicat€= which'party you a,i 7f3ltr�,tior�.
<br /> reigre :nt and pro°ride eaml,any or. v[ ncy,name. r Co6a,nn*nt barrca
<br /> ier - install +vertil dike to block itorizont,l n,0°fegsrtrt I
<br /> r n;n} :
<br /> Excavate and Dispose - remove oit ntnateJ sail and di;, in aP,rev�
<br /> te.
<br /> c .7'acc erns and dt:ss n thw party Excavate andreat - retnav centamirated soil and treat ;includes` ,F
<br /> fr, liq C ► T fi 'nut.,, se r. r ^wurlci normally b e tadx spreading ar d far ri ;;.
<br /> P� R
<br /> w remove Eloat nq product from water
<br /> _ t
<br /> tabeyi"
<br /> f +r
<br /> ntr7 in armataor,,regay a:n thL, tank �sali�fiyr and surruuntling area: Ate i Pumnkand Treat ,roundwater - gsne4a1jy er.loycd to remove dissolve a
<br /> t 1 z7ontamirants,
<br /> msrlimiav; you nus„ provide the*faC9'i,� r;a3; and fall ,,addroh.
<br /> Enh)ndd ISiodegrada'tinn use of ary'amailahleWtechnoiniry +..a•praFrtotF f x
<br /> T,t4PLE'7 N a;^ Gr i�S,{� �_ r' batt rra irgorttao of conta,i�inants.
<br /> — ;✓, Rep3ace Svp 7y - prov'dP, al tarnativr,vater su=ali1y to affected r j
<br /> Eider n�rr oIF_0e �UGcl;.agerrCy'ar,d tsegron irat Q lily Control Boards parties.
<br /> =� I r s�
<br /> rivotved. i
<br /> I _•. ,� .. Tri�atnent at, Mooku - install water treatuvnt devices at earh wellinr orr,
<br /> 5iBS'FAKCES IN4ftYEJ �� o ^_1_> of er p1ce c use.
<br /> Enter M! narge Aorl :loan 4-ty lest of �1te nazirdois'substance involved, Room is r a potion Required - ineid=_=nt is 'nin��, Cequ9rincr no -
<br /> i r �rerretlial acs inn. r r
<br /> 4:rov2.Ov' .for i-riformation on two^sullstan eF -if aper pr ate. f more than twa
<br /> sabstances leakN, list t`c two`,af FanSt-concern fdr__nleaKit. _
<br /> CpiTh'lEM - L'se this space to elaborate on anyaspectsof the incid nt.y� -
<br /> } tSCUVrkY1Ri3 Ttli:PtT S`gn the form in the spate provired. ! t
<br /> Qvide ir,for ta 'Fan n t di,cayery and aoatqt8nt_gf the leak.
<br /> SCIfRCE'CA.LSE i f'` if tJ�e form.is conpla.ted by the tank caner or his agent retain the east co'y° T
<br /> 1 t r. -- r
<br /> Indicate sorirc� sl oficfik. Provide details an taf3k aqe:.}driacity anv_ } artd forward the remaining.txopfis in tact to your 7 cal tank per"detiOp ac�cn}y f
<br /> a er>st if knor. Ci}ragl box( s3 inciicatina cause of legis.
<br /> i if r ci stributinn. = !
<br /> E 1 (srigin?1 -. Local Tank Permitting, Aganey ' �' - J• �
<br /> 4 � 7. ,State ldater Resources Control Boardji�ivjsion of Nater Quali
<br /> CRSS . YPE -a , • j
<br /> r�dicat the care type ategnry`+or this leak. Check o b ox only. Case type ,lnderground Tan Program, P (3. Box IGQ, Sacran,enta, CA 95902'• 'ti
<br /> i based an the most sensitive'resource affected. 'For example, if both Soil ?: Reg?onal Mater Quality vontrol Board r
<br /> gr i' , , type t, f4 4. 'county Board of Supervisors or designee to,receive Propos.iticn^65, ,r
<br /> and nand xater have beer, afcte cavi. e vti(1 'ke fr and water
<br /> netifictatiarrs, y ! r
<br /> ;!} ?nriicate "[rrrynking Vldter�` only if one or more aru3,cipal or`domestic vaster; �,
<br /> havc-dctrally I�ee7�affected. A Ground dater" desibnation does not a5 pwnerlr spnnsiyle party. ,
<br /> p1v that:tho,I ffecteA1"hter cannot ae; or..is net, used,26r drinking water,' ^ r` .� 0,
<br /> r i
<br /> hart only' that mer well.nava-�nat(y t Oven affected.` ill ks understood that i
<br /> ease typi:vtay;change upon'f4ther i vestigation.
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