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? .R!CT_ONS
<br /> $r tEattY CURRENT STATUS
<br /> indl„c c,e €i ether err- rgency response personnel and equipment were Involved at ". tE{1 Ce.te. tF:. C,ategory which best describes the current. Status of the`-. Case.
<br /> a, t,3nc>. If so, a oazardoas Material Incident Report sitz?uld be filed with Check one box only. The response: should. e relative to the case type." For
<br /> the .,ta..> (fieri of Emergency Ser es CES, st 2800 Meadowviiew'doaEi; xmpl+ : if case type is 'Ground Water-", then '(;urrexni Status` should refer to
<br /> r:
<br /> Sacramento, CA 95832. Copies of rite :tzEs report form may be obtained"at ,y€>€:r the status of the ground"water investigatio€a or cleanup, as E��pasE>d to:t#ate? £>€'
<br /> ,., local uridl r4round storage tank Permitting agency. Indicate whether the GE<S soil.
<br /> report has been filed as of the date of this report.
<br /> s a MPORir1 lT. THC le:?t)nl'rsT'ItI S P1t;;Yr 7FG ON 'THIS FORM "> INTENDED FOP i;%tgI;RAL
<br /> _ : � ; IS NOT TO B C
<br /> `NSTRtECAS REPRESENTING THEr� NC "* CPI I 'j
<br /> _oao� -�..TtCa_. notification ttrsuant t3 ifal;n i?fSlftty Code Section OFFICIAL POSITION Oi: ANY 'OV;R` 1ENTAL AGENCY
<br /> 25180.7., a designate£ government employee should sign and date the form in
<br /> tl=s hl cc k. A signature. here does hot mean that the leak has been determined REMEDIAL ACTION
<br /> to pose, a siyni fiCant threat t 1Fihlean health or safety, only that notificat-ion ;t2�t..a•.e rrd�€3C� aCtit}nS have been used to cleanup or.. rerIiediate the., leak.
<br /> €.
<br /> pr e€iur s have bens followed if required. Lescr°iptions of options follow:
<br /> PEPORrE.D BY Can Site install horizontal impermeabk,: layer to reduce rainfall
<br /> Ea?t r yEiur YaES ,
<br /> telephone numbter, and address. Indicate which party you infi�tr�ticn.
<br /> represent and provide company or agency nacre. Containment Barrier _ install vertical dike to block t,orizorttal ovem-unt
<br /> _. n...51"j—
<br /> _._. ..._-
<br /> of"coTfamrrrI 6i..
<br /> RESPONSIBLE PARITY Excavate e and uispose - rarrxave contaminated soil and dispose in approved
<br /> ntE
<br /> nam,., t671ephone number, contact person, and address of the party site.
<br /> responsible for the leak. The responsible party would normally be the tank Excavate and Treat - rerrkove contaminated sail and treat (includes
<br /> owner,. spwW-sirs;ss� 'find farming).
<br /> Remove Free Product - remove floating product from water
<br /> SITE ��.'�c
<br /> LOCATION t _.�.__.__..__....._
<br /> En* Crcrat?Sh
<br /> regarding the tank facility and surrounding area, At a rump and Treat Groundwater _ general'u e,,nploy d to remive dissolved
<br /> lrinitkaurn,"yQu must provide "he facility nar:'~Lx and full address. contatniiants.
<br /> Enhanced Biodegradation - use of any available technology to promote
<br /> If€riEMENTIINs AGENCIES of contaminants
<br /> Tt Y r:ir€s sf ?s€."lis,a'•. agency and Regional rather Quality Control, Board Replace Supply - protide alternative water supply to affec:€>
<br /> inve,Ive. parties.
<br /> Treatment at Hookup - install mater treatment devices at each d€veiling Qr
<br /> SUBSTANCESocher. aQC C��aS4'.
<br /> E'r t r the rd T£ and €id City lost €)E the 1azardoup substance invt)ived. Room isv No Action G'fuireG - incident is minor, requiring no
<br /> provided for informdtion on two substances if appropriate. of more than two ret..8 it al a(,tl n.
<br /> subst-inces leaked, list the twry of urost .orice.rn for ,cleanup.
<br /> CiiMf"PHI'S - Use this space to elaborate on any aspects of the incident,
<br /> =`SCOVERY:At?t, EMENT 51 �;ATU E -Sign the four fro the space provided.
<br /> ; EISRt`:"at#Ti to
<br /> P'rLside irfarmati€sn rE+gr?ming the, discovery and ata?tv'ment of the eak. �_.._._._.._.
<br /> 70;RCE/CAUSE If the form is completed by the tank owner, or his agent, retain the fast cosy
<br /> n a ate Sources s) of leik. Provide details on tank arxc; capacity and and forward the remaining copies in tact to your local tank permitting agency
<br /> "Sa..erill if ?!)own Check bM'esl indicating Cause of leak.
<br /> for distribution.
<br /> I Original - Local Tank Permitting Agency
<br /> .. ` Ty€` 2 -State Water Resources Control Board, Division of Water Quality,
<br /> ateythe -ase type category for oris leak. Check one box only. Case type Underground Tank Program., P. f.?. Boz IGC, Sacramento, €.A 9580;
<br /> is based on the mot sen0tive resource affected. For example, if both soil ?. ' Regional Vater ^uality '.'ontrol Board
<br /> and grounds2have benaffecV,+d, c..se VIDE will °Ei "vri)dnd Water". A. County Board Qf Supervi oY'S or €ies?gnE',n t€) receive Preposition f33
<br /> Indicate rinki rr Water` only if one, or more muni Icigal or domestic water notifir_ations.
<br /> wel es have actually beer, affected. A "Ground Wate r, designation does not 5. Ownerfresponsihle:. party.
<br /> imply that the .affected wafer cannot be, or is not, used for drinking water,
<br /> but only thtlt water wells have no vet beer, affected. It is understood that
<br /> "se type may change Upon.further investigation.
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