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INs_R_CT!ONS
<br /> EMERGENCY
<br /> I, kHeing Ccrf�uzed Teak suspected at sitebut not been confirmed,
<br /> Indicate whether emergencyresponse peTsoune3 and eTulpnlent were involved Pre_ian Submittcd, - worlp` .fyxoposas -
<br /> at any time, so, a -Hazardous Material Incident Deport should be filed requested ofls"iiamitted by .responsible party t; Cleterin4na wiiether ground
<br /> with the State Office o. Emergency Services (OES) a:, 2800 Meadow-view iaad, water has been, or will be, imcp ted as ra _ salt of thelease.
<br /> W e'z
<br /> Sacramento, CA 95832, Copiesofthe CES raitirt form may be, obtained at P .derw,av - imp'1.ementa,_on of workplan.
<br /> your local underground s:.orage tank pern,itti g agency. Indicate whether Pollution Ch aracto.ri za 'tin i e"j onsiblE pa.t, is in e process,of `:Fly
<br /> the OES report has bee, filed as of the date of-this report. defining the extent, o_ cc.mta:!inaii w y, ter ariassessing
<br /> er..<.;.t:.`; on SUrf:3C 't3I ground. Sk-=-r ,
<br /> LOCAL AGENCY ON--, R med-a*.on Plan ez , ati n plan, s ..m.., c e-<._c long texan
<br /> To avoid duplicate notification- pursuant Lo Health and Safety cede Section ier,nediation options Proposal and mple .<t,.0 cr chodule for app opriate
<br /> 2$180.5,-a government employee should sig>i and date thd,f`r:n in this block- remediation options also subrlutted.
<br /> A signature here dues ;got mean haat the Leak has been determined to pose a gl ail, i.>:derwav - implementation of remed_<_t�r-m Zi.az,.
<br /> significant hrea4, to Yuman health or safety, only that' notification ress - pe.r4clic i,av:<-nd h,.*"e- or othe
<br /> procedures have been followed if required, monitoring at site, as .:eccssary, to Verift' .andlc° evaluate effectiveness '
<br /> of remedial acts sesta es.
<br /> REPORTED BY Case Closed - regional'board _nd local agency in concurrence .,_eat. no
<br /> Enter your name, telephone number, and address. Indicate which party you further work is necessary at the site,
<br /> represent and provide company or agency nzuns,
<br /> IMPORTANT: THE J.NFORMATIONN PROVIDED Ctd TBUS FO zd 1S INTENDED FOR GENTRAL
<br /> .aPONSIELE IiBFTY
<br /> STATISM' RP, ES ON LY A D IS NOT TO BE CONS RU ) ; REPRESENTING T��
<br /> ter name, telephone number, contact person, said ad$ress of rr party O.FICTAsI POSITION 3r" n2vY OT IZ !L'T4 At>r;;C
<br /> responsible for the _eak. The responsible partly would--norra My be the tank
<br /> ovmer. REMEDIAL ACTION
<br /> indicate which action have been used :,o cleanup or relneuiate the leak,
<br /> SITE LQQATICNDescriptions of options follow:
<br /> Enter information regarding the tank facility, At, a minizwixn, you mutt
<br /> provide the facility name and full address;. Cali Site - install horizontal impermeable -layer to reduce rainfall
<br /> infi'_Lration.
<br />>
<br /> IMPLEMENTING AGEibCIESgoo aitment Barr;ax - install vertical dike to Mucic he izortal;arotenaaau of
<br /> Enter names of the local agency and Regional n t�_ Quality Control Board con ami'-rant.
<br /> invol=red. Excavate and, remove contaminated soil and dispose =1appro e
<br /> si e
<br /> SUBSTANCES INVOLVED Excavate and Treat - remove contaminated soil and treat ( ncludas sprea d-In S
<br /> Enter the n e and quantity lost of the hazardous substance involved, Room or lard fanmlxzg).
<br /> is provided or nfonlauion or, two substance if apprq riate, Ig more than Rearove Free Product remove floating prcidt,ct" from water table.
<br /> two substanoss leaked, list the two of most coiaern for clearniv. Lty,pp endTreat Cruuziric ter generally employed G3 _ nove dissolved
<br /> cob,.t<a Jnant--
<br /> IIISCC Y Ai3ATE E" rsh,.cod, Biole rad ,Fie use cal any ave,.lab'e te: .,logy r.o pzo::zote-
<br /> Provide information regarding, the a�scova y and abatement of the eak ;aacteibs.a deo tpositi.o, c,. r�txrr, ttat;ts,
<br /> is aoe pply' r o vi alternative water #s ly toaffected part-lac,
<br /> SOt7?? E1CAtSSE toea aen t a to es., n �a'1 water tiest.:zent devices at each dwa lli f,'o
<br /> w Indicate source;s; of leak. Check boz(es) --indicating cause of leak, other place, of Use.
<br /> iracu.,,im Extras use y ui,s of blowers ,o dxa azs� t'.._.a g� soil.
<br /> v t So -
<br /> bore holes a soil to allow vc'; L _ - a of contaminants,
<br /> ate the case type category fox this leak, L..,ci�,Qne box only. Goat td« A t n �eertrxrea - aa...rderat ri or, ?relc,_,'zxs ±io to"r;oisi2 action,
<br /> VPFETYPE
<br /> e is based on. the most sensitive rescutte affec,ed, or-example,
<br /> both s6dl and ground water have been of e .ed, case type will be 'C_ou d C -2.1-P$Ta - Use this space i to a'a''orate on any aspects of the'_nclidekit,
<br /> Water". Indicate "Drs.iking nay,a` only is one cr more r nisi am or
<br /> domestic water wells have actually beer affected'. A C-ra ._d i iter" IC,n,tERE w Sign the fora; in he peace i�_o°vi. a
<br /> designation goes not imply that the affect_d water Qannot ;e, or is not,
<br /> used For driai1s ng grater, but on y 'hat kat"ez, well: 1;ave is yet 1 > Ets DOIN
<br /> affected, it is under tood that case type may changc ;pon furt-her If t"zie fozrn is .etc-„ by the tank r,wne_ or hlis agcritrotaIrl the 11ast zop
<br /> ,invest ajar t y
<br /> ' ig . . r..,;i r�.__� t,v Asn";ail.:ag�c,i..z.4 xa.,,<zct�ty yrrar .a,e,,.4 .�,.� ;��.t�.t-_r� ��_i>r�>
<br /> CURRENT i Tti5= ?_nal ocii_, Tank ,rm..tt r„ Agency
<br /> y4
<br /> Inds ca a file category which a de a cs thecu__.. ., status of _e, casc, 2, ,null _ r;a __ �_.s3 a �s .ctx ill Board, ' _ r
<br /> crank clue box only., .he response,should be relative to the .,as tv,;,e. Fol- Underg;...ind, Sto_ax& ai, c Program, E` � ��;� Water t �
<br /> example, if .;ala type G - n er ren Zia sh, lief 2120 t t
<br /> to the status q f t,.xe ground wet__ ' s.Jga itou as ,le.at'i{"i? , ..,. =o ? Water {u _..f,� a .n,.t,rol Board
<br /> .. ,_ ,rfu_.., <_ ,4 � x.<,..al n_ 'Ofr ._c;r and C x u,.r?,y Board
<br /> n sd-`e Frooc-,—ition 65 ,z int
<br /> INo`Action T i �n No i spons.ole i y
<br /> <7 .32 ak
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