|
?2 SSRI. 'titNS
<br /> � ti Leak e;A, Ccnfirincd - Leak suspened at.site, but has nor, been „onf.inied.
<br /> Ff r'L dw^!'
<br /> indicate whether emergency ,tespsnse sonnei :aairl equipment were involve tre_a._r nary �:t.� r.>�d amen �a kalata :iczbtitted _ wra kpl nlpro csal
<br /> at any tJune, if so, a Hazardous Material.. incident Report should be filed requested of/submitted by responsible party to determine whether ground
<br /> with the State Office of E;:z aetzcy Ser—,ices (<DES) at 2800 Meadewhew :Read, water Inas been, or will be, 'irrlpa,t d His a result of the release.
<br /> Siacxamento, CA 5832 ..00e_: of the O S report form sray be obtained at imipletmntatian of wozkplan:
<br /> your local undo ao=d storage tank pormitt Og agency, Indicate whether l.l.ix*ion Ct,<r tar 2at:cr r_ .,,aSible party is in tne ,rocess of fully
<br /> e OFS report 1-as sae,.,_ filed as of the date ofthis report, defining the extent of contamination in soil -,end a-,ound .rater and aszes.kng
<br /> _nipa,ts on s ar3 ac._ ane/or grozunl water,
<br /> LG AL NEWT Q'I?V Remediation P ABM rtidr.Ki tion plan schmitted eva?uming;long t>wzar
<br /> ,.
<br /> ao avoid c?€dc"l.zca9:e notification llat..uat<t to Ili-altar. and Safety z:,.a., Section a,e=r^eda.<,tsoa options, Proposal <_nc4 lmplfmientation _clze..;:?e ..or spas ae:t-=a:,a
<br /> 2f180.5, a gsaverxz-nc;;tt employee 'shrs>ala sign and este the fc,_,n in this,h1^c.€ runzedaa.._ta: captdraszs also 5ulrc.,.wte.:,,
<br /> A signature :sere &)elw cot n=,can tuat the leak has been determined to pose a Cleanup Nrw<v - implementati n of z nme-diation plan,
<br /> s.ipif._r,ant threat to tr a., n health o, safety, only that notification t .lo,ifor itz Pia xef_'sLL periodic ground Pewter„ or other
<br /> procedures have n�.e< followed if required. ...iron .toning at site, as nobes6ary, to vorAfy and/or evaluate effectiveness
<br /> of remedial. activities,
<br /> P-1111PORTED BY Case s - regional board and ;o"I agency in concurrence what no
<br /> Enter your care telaphanp number,, a „d e ..: Indicate Ahich party You furtber work is necessary at the site
<br /> l,_esent and pa.ovxdr company or agency nitre,
<br /> IMa-C>'xe ANT. � THE �,NVO^IATION PROVIDED ON a 91S £�a; "S INTENDED FOR , NITLRML
<br /> �PO
<br /> —21110LQF fAR`:` :L Y STATISTIC P"I RPdW; ONLY AJ,;D IS NOT TO BE CONSTRUED AS RLFRra.ENTING THE
<br /> Enter nacre, ;telephone number, contact person, and address of tile party OFFICIAL POSITION ION CL ANY GOVERNMENTAL AGENCY
<br /> responsible for the:.l ah', he resprrnsi l e party,would norm,<ally be the tank
<br /> INicate nihi ?a action have been used to c earlup or rerediate the leak,
<br /> SITE 1,C AtaOlb Descriptions of options follows
<br /> 'Enter information rega_dirag, the tank facility. At a :idirzlm'IMI. You .rest
<br /> provide the facility navae and full address, (No, Site - install bwAwtal impermeable ;[a,>cr to reduce rainfall
<br /> TC,I�"MEti 7NC;I,F14CI o:ta.nr ..t llarritL - install vertical dike to block horizontal movement of
<br /> Enter names of the ;local agency an .a„ n�.il_ mate Q aiit z,,_zat-ol Board" comtoolinant,
<br /> involved.
<br /> L avato a_za., D.,,)oFo remove caz.tasr._nawd soil and dispose in S I,F.o,,ed
<br /> site,
<br /> Ils.y1, zxr IZSayat Treat - remove coma_inat.ed soil_ end t_eat;(snciu,dee spread
<br /> Enter the name and quamity lost of the hmardou> s€€bstaazc_ ;rr:bolved. Roaa2 or land .x:a zg).
<br /> its proaided for information on two substances if appropriate, if more Man Err^ove ?nee Ernduc+ remove floating prod€dc.., from water table-
<br /> two substances !asked, list the, two of most 6,oncern for Cleanup,up, a i ray:? >:c;an?d ai or - generally employed to remove dissolved
<br /> me of wwovailabLe technology to promote
<br /> Provide in olid„zt ion reg rd a, the discovery and .a .A w,,nne,t, of the teak. bacteria! rlecoctpoC A" �ioo, of contaminants,
<br /> P 111a :_ :yly y •ovi de alternative water at,,pply to affected azar;Wes.
<br /> I Kl n -, install water treatment devices at each dwelling, c*.r
<br /> illi tN .,or.ce;>j of leak. Check rc3 'a) Jndicating cause of e place, use.
<br /> L tee :aa L r cam", use p-ps or bioliers Lo draw air through soil,
<br /> Y ?'Yac Vent MI 7TRe bal.cs, in sod! to YAcw vo Ul-izmion of cobtmAnants,
<br /> Indicate the case, type ca Ngo y forthis leak, Check one box only, Case ED 1510 R,!. red - inra.dent is nlinox, requiring no Mem d al. action,
<br /> type is based on tim most sensmne r e_,ccs;ce affec..o€i. Fos, xar.x.Le, if
<br /> both scil rad ground wave.,;- have been affected, case type will, be, G.to ndl ` .2`l`A_S - Use this seal e to el_a,sr:at,e on any aspects of the incident,
<br /> Water", indicate `Slrinkine, Atm" only if one or more munigiT>al_.or :
<br /> domestic water wells have actually been affected, A Around Water" :15;>ic:12E" - S_gsz;Me form in the space provided,
<br /> designation c:oes 'hot n2,.,.y tt,at .too <affected 4at.,er cannot, >e, or is not,,
<br /> used for dr:nkin water, b€at only that calor wells. have net yet Peen DISTIZIBUTION
<br /> affected. it is understood that case-type may e`:-,<ange upon further 717the foal is cowplet,eci by the Wa;lik owner or his agent, retain he ,ate,, nopy
<br /> 1ddlm tQa,,%L7YF
<br /> and forward the remainingcopies intact:to your Local- tank ,»rini >e ing agency
<br /> tvr d",S t 1,ibr l,.w..,Y,..
<br /> Orig-inal Local Tank Pen-mitt, ng A;aawy
<br /> ...z.._„<s... the r_atego:..y whAhz best desc.,Res the ea<a__'.,nt ctatus of t'ne case. 2. . Stat.: Water atf.>oa_ces'Control Board, Diviaion of Clean Water Programs
<br /> Check cue _ox only, .he response sh3 x 'be relative to the ,as type:, For t,ndergir.nnd Storage Trak Pxogram, TO. Box 94421, Sacrasnento, CA 94;.,,,-,,4-
<br /> if -are type, is "Acaec,u Water”, then '"tureen-, utatu' h. o'l.- refer 2IL2?
<br /> the s^, of the ground water E r. �,g<a _r 3 or a€d,,p. ;as d to Regional later Qsnal.ity >ont.rol Board
<br /> ,
<br /> of optm ons follow- 4 Local- „i..<„ h Officer rd £.corny Board of <2u}.,., .a.: � c_ -�t.^. ..u'J"gn_c,
<br /> that of w?7,:._. af'.,C_T',X,..,,z,,YtS to
<br /> <, a _
<br /> No ,pax=.>, has ..e.., t_, n by responsible pamy ^a y,.,i s, CArner/respausible paxty,
<br />
|