Laserfiche WebLink
f •UN <br /> DERGROUND y.._,u., ,..,�..�,; - �..,•tea.-,�_.T,�...�,....,..�r. .�� <br /> - ;. . : _ STORAGE TANK UNAUTIORIZED RETE_ASE^(IrEAK)1 CONTAMII`fAT10N� <br /> Sl <br /> EMERGENCY-E4 EMEAGENCI"v <br /> HAS STATE OFFICE OF EWERGENCY'3�V�S � � .-- <br /> r <br /> - r REPORTS FILED 7 - FDR LOCALAGENCY USE ONLY : <br /> YES is ' xtt0�` r" n YES'Q tya " ^ 'E'NEREBY CI fTTIFI 7HAT I AM A��53C7lATE(1 GOYEAII�AFJ(I EMPLOYEE AND THAT.!HAVE <br /> '. ::. . 0 <br /> I. RE?ORTDA �.-. , _ - R�EP�� THIS-INFORMATION TO LOCAL C1FF)CIALS PURSUANT TO SECTION 251847 OF <br /> TH AND 5AFT1 CODE <br /> 1 NANE OF INDIVIDUAL FLING REPI]RT 'N <br /> i) tt •.r _5t w C n r -t C 1 P�HfON6 T r SIGNATLNRE sm OITE <br /> Ir m� - G Yt O �b �`S —w.Y� .� .. .:1... mer {Z.x)'•� _ _ '. <br /> o <br /> REPRESENTING yy� „7 _ <br /> �r h_„N +,a❑ OWNER+OPEAATOR �'.;REGIONAL BOARD COMPANY OR AGENCY NAME <br /> ` O �TOCALAGENCY ❑ OT7 EA r . ..., <br /> ADORESS�Yr”`CL <br /> t„ysC�r1*F'vi •-'V- <br /> in- <br /> 2- <br /> •'r ' `�+7 t �Y i1 � yr N r , -� r•- i � ` 7.-•, S .}+••+`--►*'{l,-� o:►.+}I:t;+�i;�.l� 1 �J. <br /> r - , Pte. :alt ..:� ";�. ; 2yc� :�•,,.� .$�-1?aR�..;r.; , _ ''. - + �'.a.--R.J .! `rcf52- - - <br /> 'ol <br /> T �> [_iI .?x^l : • a • �� y c n+y. CONTACTP <br /> I / .. ;' .•• :c.r t: 1,� a _ m � � ,v 'PHONE <br /> z�. A�,O _ E;y:!+'a+x a =C b e c' ! :� W!Q!OWN � s t 7 <br /> 4ADDRESS _ euvc v4__ : w�- <br /> o „ <br /> .. .. <br /> I yd <br /> l y •� t/l ..>.+ gEET ><k .L� - -.1Y.� r • �"S�.�C��Y S �'L.�-•Y;�'V M h -• V f.c, <br /> r FACtsT1 NAAiE(IFAPPLICABLE) r p� ST <br /> T ' av <br /> Z �DRESS <br /> r, ` r_ _ PHDIJE�'-I�KCG 'V,y[ �,. :Q�• 1.M IID t' `1 �4/ YJPVJf l�V4 �LLF•1 cf <br /> C, CROSS STREET'-.:Zr rfv cou n <br /> TYPE OF AREA { <br /> - COMMERCIAL PNDUSTR TPE OF <br /> ❑ U1L BUSINESS <br /> ❑ AURS NESS <br /> . ❑ RETAIL FUEL STATION - <br /> r?SpRES�ETITUL" OTHER <br /> ! LOCAL AGENCY. FARM�r QTHER: - t <br /> I rn T y ;r.AGENCY NAME CONTACT REASON <br /> z� c-.,� ^ r� L��a:i .. �e�i`'��,�`=�� k `t.. -L.��..',c- G.�-� `��G0�°� � h�•(� . <br /> jl REGIONAL �' ►12�`-.. I <br /> 3'6 r- <br /> NAME <br /> CUANTTTY LOST(GALLONS) I <br /> DATE DI ❑ <br /> UNK <br /> N <br /> ower <br /> Il' SCOVERED . <br /> I. w �•rr "r, ., HOWOISCGYEAED. WVENTORYCONTAOL SUB FACE MONITORING a� <br /> 3 - .. NUISANCE CONDITIONS <br /> �Y Ff v ❑ TANK REMOVAL . ,' .❑ DTHEA <br /> DATE DISCHARGE BEGAN _• METHOD USED TO STOP DISCHARGE(CHECK ALL THA APPLY <br /> :: <br /> �• .'.t z -- a .._ - <br /> u¢e u "y ..p.., .p .. r r- �NKNOWN ❑ REAIOVSCQNTTNIS REPLACE TANK <br /> HAS DISCHARGE BEEN STOPPED 9.-,:9 t t„ 4 ❑ OSE TANK' <br /> ,� REPAIR TANK - ❑ REPAIR PING �j y O CHANGE PROCEDURE; , <br /> B n5 NO'"IFYES.DATE pu� u� �p�`Vp� �Lr�^ �r ❑ OTHER <br /> Lu SOURCE OF DISCHARGE --- - <br /> h TAIrKSONLY.C.WACITY MATERIAL' " CAUSE(s) <br /> _ <br /> ( :❑ TANKLEAIC "�GNKNQWN' va 'r ' GAL C ❑ IS O ERFlL 4 , ALURE <br /> U Y ` ❑� .v .RIPTURE�F <br /> r4 ¢ s PIPING LEAK e r y a <br /> r -5. ._ _�_• R o-rwg�y'�TE0., vt �. - ^ ,CORROSION TM p(]Zpy,j,rt�"'T•;• I <br /> UNKNOWN �r y r T� ,;u.r❑ OTHER fl ` t Q SPIEl?�Q OTHER. <br /> TH <br /> EA <br /> ty ty CHECK ONE ONLY n" .-.•r ._ _ = --�—4 <br /> I - U 'LINaEI'ERMWED 'y�0 �- .r, �... •a,•.:-.µ'�,T .: s .z. .-, + .v.r,,4;- .�_. . - <br /> ❑ GROUNDWATER -❑ ;DRINKNG WATER_= (CHECK ONLY F WATEA WF1 I S HAVE ACTUALLY BET]1 AFFEC ^ - <br /> ` i U) CHECK ONE�ONLY�q�r!},'.'qrr t� r.r :, .r±::'i- er ^;4 r�;:; -•r <br /> ' a R ' Q SITE tWESTIGAT1pN fN PRnGRE55 <br /> (DEFWNGEXTENTOF�ROBLECLEZUPINPROGRESS SIGNED OFF '; �v` <br /> • r (CLEANUP , <br /> MONITORING W PROGRESS '.C�iM7 FrUNDS AVALABIE TOP �5� <br /> -r '— _ _... .., ROCEED:y;Q I1/AIJ1A71NGCLEANTAI-TEWVATTY&S <br /> [NECK??PRO?RIATEACTION(S)(SEE BACK FORCETAILSI- Pt r..• , �i..� yi. .�_,_ ,,., -x y c, <br /> .._ •:.,F.�;-r..L .....-. 'p-v.i ' - w:. :p XY,;. i•Ta� .t,-. ;!, -� _'p'!ir ?r' ,` Z ` c;:;.. i"-i's ... , <br /> °❑'CAP SrTE(CD) +. )+ . y x s l'•u�ra ..s ' `,; !ss: ° .e�' �cJ�,+e ai. d1;,f' <br /> + ,r -- 2x x r r•m r EXCAVATE t DISPOSEtA'EMOVE FREE PRW_ T(FP] -� gRANCEO BIO DEGRADATION <br /> 't. <br /> �.•+. ;r OON'TANNM N`SA (CO)' <br /> •+4.a.t ATF&: �.1Ra�rf.j s+. Ducap�.+ .r.,.•v. _-.v.,..rw.?.{u�- .. ti•+:w...�., '. ,.�;«r.` ,y;< <br /> 'F ENT BARRIER CEXCAVATE Nk TFiEA7{E7) « _ � PUMP&-TREAT GROUNDWATEA.(GT) REPLACE SUPPLY <br /> y <br /> ❑ <br /> TREATMENT AT(IOOKUP(1 N N) _. <br /> _ NO ACTION REWIRED(NA) .'OTHE (OT). _ - + <br /> w v! vi;uy <br /> S ` <br /> € I <br /> I <br /> MSC ix3 <br /> Tush <br /> I� H <br />