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=Cd abutburias not beer. con`i 1--med
<br /> .,�ak suspec!
<br /> W•re Ltiv,)Iv!id Preli:iiin,,i - workplan/proposal
<br /> Incid�,nt, Report snEDUid be filed requcsted
<br /> a I determine whether grni.tnd
<br /> r-, f the release.
<br /> or will 1-_-, impacted as a result o
<br /> .�;.,vices ('-ES) at. ZU0 Mqadrmviaw Road. water e
<br /> Preliminary Site Assessment. Underway - implementation of workplan,
<br /> 3 e ULS report lorm mai La obtained at
<br /> Indicate whether Poll,iticn Characterization responsible rarty is in the process of Pully
<br /> Ir_ C Ue date of this report. d,?f-i,,..ng thle extent of contamination _z: soi elna ground water and asser,,,_
<br /> ns
<br /> impacts on surface arzliur gourd :water
<br /> V - remediation p-an sul,m,Jttid evaluating long term
<br /> RemediaLion Plan
<br /> "-:1 and SafeL.J. rode Section�:-"Jajjt, to "=a-th remediation options. Proposal and imp Le -ntaLr - schedule for appro,._ut2
<br /> 1-1 _,gn an-] iate f.te farm in this block. remediation options also submit--ed.
<br /> t1 :eek has been determined to pose z Cleanup Underway -- implementation of iemediation plan.
<br /> eDZ- F;afety, only t.tat rot.fiea ice, lost Cleanup Monitoring in Progress '- .)eriodic -round water or cyber
<br /> iul red. monitoring at site, as nvcpssary, _c verify and/or evaluate effectiveness
<br /> of remedial activities.
<br /> Case Closed - regional bo.rd and local agency in concurrence that no
<br /> ra! further work is necessary at the site.
<br /> and address, indicate which party you
<br /> --A grey cane.
<br /> IMPORTANT: THE INFORMATION PROVIDED ON THIS FORM IS INTENDED FOR GrENEF-A.1,
<br /> ? ONLY AND IS NOT TO BE CONS ' THE
<br /> PLJR W 6 Of TR'JEI) AS REPRESENTING
<br /> STA _ICAL
<br /> c. S
<br /> person, and address of the party OFFICIAL PO ITION-OF ANY GOVERNMENTAL AGENCY
<br /> a the tank
<br /> -
<br /> part- 4culd normally b
<br /> R7EDIAL ACTION
<br /> Indicate which action have been used to cleanup or remediate, the leak.
<br /> Descriptions of options follow:
<br /> En,e'r trfforn,.ir_iun rogar:_,iittl ti,o tajj_k fa,-ility. A� a mini-mrzo, you an s t
<br /> _Jty ne
<br /> the f-a"j. . horizontal impermeable layer to reduce rainfall
<br /> 1.1ill address, Cap Site - install
<br /> infiltration.
<br /> Containment Barrier - install vertical dike to block horizontal movement of
<br /> ti i n anm:s f Lh e >1 Fre and Regioual Water Quality Control Board contaminant.
<br /> Excavate and Dispose - remove contaminated soil and dispose in approved
<br /> S 1,L,_;, . S Excavate and Treat remove contaminated soil and treat 'includes spreading
<br /> .....
<br /> 'rc li'l-e
<br /> !:,
<br /> 'I �A . of tthehazardo,.ts siubstance involved. Room or land farming).
<br /> P
<br /> ice infinuaL )r tw,-, substance -,f appropriate. If.mo-re than 1 10%, �; Remove Free Product - remove floating product from water table.
<br /> two zlbstances leaked, Iiz,, tw,, of mcosl concern for cleanup. Pump and Treat Groundwater - generally employed to remove dissolved
<br /> contaminants.
<br /> DISCOV:-MiABATEMENT Enhanced Biodegradation - use of any available technology to pro Mite
<br /> Fro:-de inform-inion the dispovery and abate-uent_ of the leak. bacterial decomposition of apptaminanLs.
<br /> Replace'Supply - provide alt#,pnative water supply to affected parties.
<br /> if rr%CEi CAI' Treatment at Hc(3LAL;p - install water treatment devices at each dwelling or
<br /> Check ax es7 indicating cause of leak, other place of uae,
<br /> Vacuum Extract'-'use pumps or blowers to draw air through soil.
<br /> jASE TYPE Vent Soil - bore holes in soil to allow volatilization of contaminants,
<br /> 71,.2icate the ;ase tyc;i ;:or this leak. Check one box only. Case No Action Required - incident is minor. requiring no remedial action.
<br /> "Pe 1S bcc-i :n the w*t �'rescurce af�ected. For example,
<br /> hoth soil anJ ,_ourid water have Le5fi affected. Case type will he "Ground CUIMENTS Use this space to elaborate on any aspects of the incident.
<br /> toner". Indicate I;rinking, Water" only if one or more --J=icipZ_ or
<br /> "onlentiQ —ter wells _.ave, act,,;aLLY been affected. A - und :later"Gro at, SIGNATURE -Sign the form in the space provided.
<br /> designation does W)t -ap1l'; tl;at, the affected water cannot he, or is not,
<br /> Used for d-_,iukin-g water• hut only that water wells have riot yet been DISTRIBUTION
<br /> affected. It is understood that case type may charge upon further If the form- 4.s completed by the tank owner or his agent, retain the Last copy
<br /> investigatinn, and forward the remaining copies intact to your local tank permitting agency
<br /> for distrib,-tion.
<br /> CURRENT STATTJ Local Tank _enrii"Ang Agency
<br /> Indicate the category vai.cY t,,st, describes the current status of the case- 2 Regional Water Quality Control Board
<br /> Check one box only. 711,3 respx;nse sliould ha relative to the case type. For 3. ".ocal Health Officer and County Board of Supervisors or 'their designee Lo
<br /> example, if case tyj)e4then "Current Status" sh-ou.13 refer I eceive Proposition 65 notifications.
<br /> to the tbs p':-.,n ; - or cleanup. as oppose- to 'responsible party.
<br /> 4, _,wner
<br /> that of soil. DeZcr1r)rn43 of oPtns follow:
<br /> No Action Take!' No 1tior has been taker; by-responsible,party beyond
<br /> in't-a'
<br />
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