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<br /> RvE1CY Leake Bein& Conf'irarcd;- Leak suspected at site; but has not beer, confirmod,
<br /> Indicate whether emergency response pe*°scaxnei and equipment were inva-31 ei rkpia3 Subm ted -° workolan proposal
<br /> at",any time, If so, a Hazardous Material- Incident Report should .e H filed reguest;od of,/submitted by responsible party to determine vrh than ground
<br /> with the State Office of Emergency Services (OES) a; 2800 Meadowview Raid, water has been, or will be, impacted as a'result of the release:
<br /> Sacramento, CA 95832. Copies of the GES;report fo at t ay he obta-ned <at Ba elrim'nar Site Assds menu Trader av - isrlemen tat:c.x of workplan.
<br /> your local underground storage tank permitting agency, Indicate whether P01.111tio.a ChoYa.,teriZation responsible party _is in the process of fully
<br /> brae OEES report hps been filed as of the date of this report, defining the extent of contarninatior in soil and ground water ilial as:;essi g
<br /> ..apxacts on surface arida<or gro, d water,
<br /> LOCAL �'A;ENCYti ONLY_ omediat_en.Pl_ar< - remled_at on,plan sWoMitt,ed eaa?za..ing long texr
<br /> To avoid duplicate notification pursuant to Health and Safety co..,e Section remediation captions. Proposal and i ,;_.. entat!on he ule foo z<ppropriawe
<br /> 2-1180,5t a government enp®oyes' sLaul szgn and dare tlxs'_o_a, wn til s l,lr,ck: reneaaatoxx pt.ax.s lso sul°a.btLes.
<br /> A signature mere does not mean that the leak has been €etexa..ixxe< to nose a C.Leanv ix alemeritation of remediation plata,
<br /> s.i.g.xrf'icant threat to human health or safety, only that notification, P Cleazio 3c xxror in Pr'c>ress periodic ground water ars o t,n
<br /> procedures have been followed if regui_red zronitc ing at site, as necessary, to verify and/or evaluate i zf.ec„zveness
<br /> of remedial acttvit. es.
<br /> REPORTED BY Case Closed - regional. board and local agency in ccncarrence that no
<br /> .Entex y<zur name, telephone nuimbe_, arta address. further. work is noc•essax at the site.
<br /> `Zn�mC�te which party ya;:x Y
<br /> epresent and provide company or agency name.
<br /> IMPORTANTTHE =N�'C.T IATION PROVIDED ON THIS FORM IS INTENDED FOR GENE&AL
<br /> RESPONSTIILF PARTY STATISTICAL PURPOSES ONLY AND IS NOT TO BE CONSTRt IE'D AS REPRESENTINrG THE
<br /> Enter nacre, telephone number, contest person, and address of the ;warty OFFICIAL POSITION OF ANY vOt7ERNIIENTAC AGENCY
<br /> responsible for the leak. The responsible party would normally be the tank
<br /> owner. Px;;MEDIAL ACTION
<br /> indicate which action have been used -so cleanup or remediate the leak.
<br /> SITE L( ATION Descriptions of options follclw:
<br /> Enter information ragardirg the tank facility. At a minic:a:ra^^r, you must
<br /> provide the facilityname and full address. Lap Sate -:;install horizontal irpez eable layer to redhic:e rainfall
<br /> inti.tration.
<br /> IMPLEMENTING AGENCIES Contai.nment Barrer stall. vertical :like to block horizontal movement of
<br /> Enter names of the local agency and Regicna_ Wate- Quality Control Board contaminant.
<br /> involved, Excavate wild p..,iacse contaminated soil and dispose in apj�roved
<br /> sate,
<br /> SUBSTANCES INVOLVED Excavate and Tx-eat - remove co taniinarec soil and treat (inclUdes sp 'ead�ng
<br /> Enter the nattxe and caaantity lost of the hazardous substanc4 volNed. Room or land farming).
<br /> is provided for information on two substances if appropriate. _Tf t..c_d .A n Remove Free Product nerd<-e 1hating productfrom water to Lr
<br /> two substances leaked, list the two of most concern for c __a{.o. m,; anire<at. G-oland^neater - generally employed to remove diss......xtac
<br /> cn t u ina i
<br /> DISCOVERY/ABATEMENTErat..., s i .7_ode s aaa ie 1 _ ease of any a. ilax s e technology to tr mot a
<br /> Provide _nforc,a#,s.on xega-rdirg the discovery end abaterr_e=t of the -_yak. baicterlaaecomposit1onot c,r t rr-nants,
<br /> i?xx :"ace �c�d Z r i Novi . alternative water ),iy to aff.ec� d p<�l t>.,es.
<br /> SOU Rp,E CAU . e
<br /> I Sr.. _ e���e t a�. .actkeo - a�zuNual Haat:�r t_caament devices, each %w_ilxng or,
<br /> Indicate .:>nurce;si of leak, Check ra.,t,es; _:€ux.,=t_:ag ca..-x_ of I>ak, other Place of use,
<br /> ya u"'. Extract use rztn5 .z blowers o draw air through soil
<br /> SSE-IYPFVent Sci- laoae hole, in soil to al,ow volatg.._za,ycn of c l:,, ar narlrs,
<br /> Indicate the „else type category for
<br /> ma
<br /> ype S r this la . C1eck one box only, Case x Aotion _Pecaaared - inciIri
<br /> .dent is minor, requn _,n .area.: ».
<br /> actrta1,
<br /> type is based on the m at sensitive re=_oFu,-ce affee ed. ' ler example, _
<br /> bothoi,t and ground water have been affected, case type will be G.:auaa? Clye >iS - Use th'i's aa„e to elebol-ate .,, sny aspectz of the incident,
<br /> Water", indicate Drinking ra only if one or male municiop_ or
<br /> domestic water wells have actually beat affected, A "Ground W'a er 1�.1JR-F - Sign the frame irk the spare i_uv idled°
<br /> designation does not icply that utie affected water cannot be, not,
<br /> used for zdri-ok nig ~nater, but on-y tharl -later wells have not yet been ie Vit..
<br /> affected, s tt lex tool charge upon Turf<:.,r wi the form s .,.,amInt.ed b the ,� owner o a,eas.,, eta_.. s, ..r.
<br /> z 1
<br /> .. .,,: ..tea:..€'--a:,L' L",�33e F.l.� �Y 'F' _ 3�3
<br /> rive z tJ g a...on. as:a rcr.w_.nr t_ e aa_ning`cop. es intact to -vou_, ._c,ca�, tn..t e2 . t. >,. _��,ryr
<br /> fr-C dl 11.st_-i)),.i,<..:..<::a.
<br /> 2TRRENT 'a:i, 1. „au.lnax Local .ark 1'a. n_tf,xx;, Agency
<br /> r x.1 cat e the category which best d2 c >es ' st<,tus of case. 2. 6 r: ��.o o x�_ Board, Dc<a,. a'
<br /> Check one ox ,.ly- re at've to the cas type, Fu `rad ,s,. SAc raga Tank _ .,
<br /> r <
<br /> .:
<br /> , The �c.pup„x. shop<�.. z;<, � ,., Ta ��=z.�.,. - � 7 aC:r�.3t,, f ,.
<br /> i
<br /> 'L ZC'L�� t f 3 ,&_ a cs=C i S e .i C!' 2 12 0
<br /> o I'e, zt_,>.,, of wb.F ground wa.ter tt .eztig<a,._�_. or cleanupa,. oposed to 3Pc.g ala Quality
<br /> that .,c>c.ri tion .app ons z: awl _ S,ocal t. �..rx, r'- Board t f :
<br /> Na Tn,1ken Nc, Pction 1,e t.....:a by .s_on Flo p u »_` _.�.` aa, ,'sa L_ ra t .
<br /> 0,
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