Laserfiche WebLink
i <br /> UNDERG UND STORAGE TANK UNAUTHO IZED RELEASE (LEAK)[CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY TIE: <br /> `FOR"frOC ' ENCY1757=QtELY REPORT BEEN FILED 9 HOYESr: -CERTTHAT 1 HAVE DIST UT.ED TH151NF MATION ACCORDINGTOTHENO YES <br /> DI BUT!CAl S ONTH T!O THE.BACK PAGE OF.TH<S.FORM <br /> REPORT TE CASE• <br /> I <br /> NA INQIVIOUAL FIPNJS REPORT PHONE SK3NAPAE <br /> V16 8,,0 53 164—m} <br /> LLJREPRESS 1 G 0 OWNEWrOPERATOR REGIONAL BOARD COMPA OR AGENCY NAMEV. <br /> d LOCALAGENCY a OTHER / h <br /> f <br /> cc AD D E S <br /> N' TRrEl <br /> 1 NAMFE CONT T PERSON fPHONEfo [�7 <br /> UNKNOWN G <br /> z� <br /> 0 QADDRESS r, <br /> a <br /> y vre rLe S ' <br /> w3 <br /> orryST <br /> sTATE zip <br /> FACILITY NAME()F APPLICABLE) OPERATO PHONE <br /> a v1 It'} u Cc } 4��y-y21 <br /> U ADDRESS IDT � <br /> 01 <br /> w atry f COUNTY ?gF- L3 <br /> CROSS STRLk:T <br /> O L AG i� AGENCY NAME CONTACT PERSON PHONE <br /> F-w <br /> �w R IONAL BOARD LL, PHONE <br /> a w <br /> NAME QUANTITY LOST(GALLONS) <br /> i <br /> W p O <br /> Q J <br /> 1 UNKNOWN <br /> m° (Z) <br /> m <br /> U) a <br /> UNKNOWN <br /> z DATE DISCOVERED HOW DISCOVERED ❑ vENTORY CONTROL E::l BSURFACE MONITORING Q NUISANCE CONDITIONS <br /> w ❑ <br /> TANK TET TANK REMOVAL Nr <br /> OTHER <br /> �ol 1 <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHA (CHECK ALL THAT APPLY) <br /> UNKNOWN REMOVE CONTENTS CLOSE TANK 8 REMOVE E�]REPAIR PIPING <br /> LU <br /> O HAS DES AGE 8EEN STOPPED 7 Q REPAIR TANK CLOSE TANK&FILL IN PLACE CHANGE PROCEDURE <br /> n � 6 Oo REPLACE TANK OTHER i <br /> LLL���JJJ YE5 NO IF YES,DATE <br /> SOURCE OF DISCHARGE CAUSE($) <br /> w <br /> 3 TANK LEAKUNKNOWN E:jOVERFILL RUPTURE/FAILURE SPILL C <br /> rOn U [D PIPING LEAK Q OTHER a CORROSION UNKNOWN a OTHER <br /> 4 <br /> w w CHECK ONE ONLY <br /> rn 4 <br /> o UNDETERMINED SOIL ONLY GROUNDWATER DRINKING WATER •(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> w F7 NO ACTION TAKEN [:j PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED POLLUTION CHARACTERIZATION <br /> yLEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY [—] <br /> POST CLEANUP MONITORING IN PROGRESS <br /> V REMEDIATION PLAN E:] CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) EXCAVATE S DISPOSE(ED) O REMOVE FREE PRODUCT(FP) ENHANCED BED DEGRADATION(IT) <br /> I�a.cn Fon o6rus7 <br /> Q z 0 CAP SITE(CD) EXCAVATE a TREAT(ET) Q PUMP a TREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) <br /> Q ED <br /> CONTAINMENT BARRIER(CB) NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) VENT SOIL[VS) <br /> Lu VACUUM EXTRACT(VE) OTHER(OT) <br /> z <br /> be /'V 4_ 7� -� ,- <br /> W <br /> U <br /> Tom- s <br /> lrSC 65{9901 <br />