Laserfiche WebLink
UNSER-GROU�[D ��3AGE*TA I 1 GRlz E ASE-n EA� / *� r*fA ryV y <br /> Ll'�r;i'//�0��1 I+1N111v �.��E.PORT <br /> ? EMERGEN[,"Y •`:`� HA9'BTATEOFEICE "� <br /> REPoaT DATE <br /> M i4 <br /> - AME OFANDIVIDUAL jr. AT `ss.-57� 3. -PHONE L �% f"� ai' <br /> - r 1; � ��.»n �x� o ti• roT� x $IGPU a y.'�. r v i Yx•' <br /> 8 REPRESENTING c n`�v. i ONIf RfOPEitATIDi .❑ REGIODI ,AOAFIO _C MPANYORACENI,'YTYAME <br /> cc <br /> LOCALYro +r r r <br /> ADDRESS y.w '� s a',4 •. <br /> ev <br /> _ �' _- a '`jar ,_, flTY � -� •,• <br /> Uwe <br /> ,CONTACTPERSON <br /> F <br /> ADDRESS _, " : L�AaIOWN <br /> Iolab <br /> ACLITY NAME fFAPPL geLq. • _ <br /> OPERATOR- P.ADORE <br /> ro HD[ <br /> IST3 STREET r r•o A 7YpF OF AREOOM7YEERCIAL❑>rIDU37RIA�❑RURAL TYPE OF BUSglE33jIETAN.FUEL STATION <br /> f i <br /> �:' ❑itE5>D (T1AL OTHER ❑ FARM, OT(iE <br /> LOCALAGENCY - AGENCY CctyTACTP SON PHONE <br /> REGIONAL BOARD PHONE{ <br /> NAME; - - QUANTITY_ LOST(GALLONS) <br /> u UNKNOWN <br /> . owN <br /> DATE DISCOVERED. HOW DISCOVEREQ ❑ INVENTORY CONTROL ❑- SUBSURFACE MONITORING ❑" NULSANCE CONDTTK)NS <br /> l u l7 u n n y.' r ❑ TANK TEST. TANK REMOVAL OTHER <br /> GATE DISCHARGE BEGAN MEnm USED TO STOP OISCHARGE M <br /> . (CHECK ALL .°- <br /> wi? UtVIQ104YN >❑' REMOVE CONTT3VTS ❑ REPLACE TANK CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED? ❑. REPAIR TANK - '.REPAIR PIPNO ❑ CHANGE PROCEDURE <br /> o YES ❑ NO FYES.DATE 1 .1 ❑ OT1 R <br /> o r v <br /> H SOURCE OF DISCHARGE TANKS ONLY.CAPACITY MATERIAL CAUSES) <br /> TANK LEAK �UNKNONN GAL.. ❑ FIBERGLASS ' <br /> ❑ OVERFILL'. ❑ RUPTURESALURE. <br /> PIPING LEAK AGE YRS STEEL ❑ CORROSIONUNKNOWN- <br /> OTHER UNKNOWN ❑ OTHER ❑ SPILL OTHER <br /> iu CHECK ONE ONLY w <br /> C7� ❑ <br /> UNDETERMINED SOIL ONLY . ❑ GROUNDWATER ❑ DRNKNOWATER- (CHECK ONLY IFWATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY 1 <br /> = <br /> a SITE INVESTIGATION IN PROGRESS(WINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> cc <br /> v`� ❑ NO ACTION TAKEN 0 ,POST CLEANUP MONITORING N PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> ❑ GAP SITE(CO) ❑ EXCAVATE A DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BK)DEGRADATION(fT) <br /> C ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE d TREAT(ET)' - PUMA P 5 TREAT GROUNDWATER <br /> �! ❑ ' (GT) ❑ REPLACE SUPPLY(AS) <br /> TREATMENT AT HOOKUP(M,!) ❑ NO ACTION REOUFRED(NA) ❑ OTHER(OT) <br />