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indicate whetsWnq.my _,_ .,_s_ Inhmmy, Sits hasesement workplanquoposa'-
<br /> <.r my €,meif w - own. ...:: ... .. �<.l s--,_. d be ..iT..e,a off/subm,,tned 10 lesparan1le party .., jetermins, __..__
<br /> - ,:., t -s.Co' CO , , �v , ea, rev-- _ R;.4..,. _ser as been, or. will-L _� �.;Md s zx . U ,. _3_�
<br /> r=max. . _,� c .,,.. „-� �> :, ,._ � release,
<br /> x:,-. z€..,.t ...0 9580.<. _ _ of Lte, ,t dorm inay, lb. obtained, at -e l ir, Urd2= sts,�e.,.., v u_F._ A, w.,_ _ __.
<br /> your local and USE _..
<br /> the - ES report, r ab C10., M&C d tc of tMs r.,,,tet. _ n"s t to extent ,or;t __nates n., in . ,,a , __ --_.,
<br /> surfaceon
<br /> mo/or ground �ater
<br /> NrVandinznno Elmo Ev ato_r plan _ , -_ ..ao eva1uating term
<br /> ,.o ovoid ..._ nyovnw, zwr=nt to HqMVhn,.z:. Safety code «G;t3.L'L ..._P;:53-,_J2> _...., i�roposal _, a .....:,.>., .,...., a.t...,x,a_., for _... .,
<br /> .� .,.,,. - �.
<br /> l,,....-, � � .._,,. ... ,. .> � -_:- 3.. ,> ., _Sfa S. ..�_>� 'X3� £;k> _-...�.s_a..�_,._ 3 _..�.. U'.:_..ry .,_A,.,sa,.,,_..2-
<br /> u
<br /> .eA has been _ .,t-..,..c3..s-.._... no _._ a ti..L.%L*.I9 ;3 n&d yt r:3", .._z..,.. :,:.,g,�u of remediationn
<br /> e-
<br /> v
<br /> . . _ .
<br /> � r
<br /> . e_K ,.,�,) � � ,�� , £ t.,.-e ... -:' mac. _ -e '�`,...__..... periodic .w',3.L uwJ,..>,x water... r.. olther
<br /> `,.ave _�.�'s z ,..: e. activities,Lite,
<br /> J.�_Sw .�t_� at L= e, as _ecessci,._3s o verify and/or g;n..,z:.,,..�. .:ffec,i _mass
<br /> _ of remedial 2cti t e _
<br /> �i _Case .,l.t.afQ evissar,:- a7xs<9.1"f. ;:L7-"., !3Cal agC,n'y in .,...u,....,._i.,.,..,.- that no
<br /> eyour, nace, _ _ and ,,dress, s s e h u further work __- ecessary at t_ra site.
<br /> .o, .1 }'
<br /> ' _A-T«_E- _ �..e_. `TEa a uT,CzL1J?iJSrES C_-"
<br /> AND e.. NOT =u BE ,`vas c .R.71.i: ...9 _to,,
<br /> Enter namy, tshephon, ,. . .,. . ct pe"rs,n, and adldreos of the Party O FICII�L POSITION OF AM DDIVERNRI,N`r. ;,,
<br /> VZpannsle for thy ,...-, .(... .. ,...�... ..t arty w-:;eld ..,...zly be the -
<br /> indicate 'which action hme been used to „lea uip c_µ remsdia-:s zhe leak,
<br /> Descriptions of options r to
<br /> Enter _nha a ionY ,.. . ,._
<br /> , e . f ci, ;ty_ At. a _ .< mast
<br /> ea erre fazx._t, ,.>� .....J u_.. aa.1u� is Site - install horizontal imperriealblec to reduce _<ti_x - _
<br /> irfiltratfor,
<br /> tsrruinstal! wortical dill. - __ ....uxx ..,:x ...o ,?l ,ra.,,c .. of
<br /> Doer owns of Lh, ",wf 'ReL,�ienal Water
<br /> Control- Board car t ami nan,t,
<br /> ,
<br /> im-Mved,
<br /> k maV"ut-. and .,D
<br /> S_.,..s3:&an-ye .,unw..,.=a,:c._...a ;ao3. ?�, _ in apooroved_
<br /> site.
<br /> n�5.;a.;n and _dt«t - .era:=.e ._ar.ama.rrat,ed soil and treat
<br /> _aazc ..>„ 1"L of the _a .. o _uL t,,--n _ inmsolvsd , Room or ;and fa__..__ .
<br /> ., _ ��aa � d._ � __� floating. product ��<._ - __
<br /> ...i sabstances, leaned, 5z the two of nm__ ecewero ¢ce __yah p, ��r �_ ;x s,-Ing-.=_ g. ,,KaLty c Toyed t Yarm)- _ _,i_-. ,ed
<br /> �a x ,y �.�aik_v..; -.c. ,._ ! ) ._.,,,..
<br /> i2211i2211LY Q±11Z provide
<br /> -nt a �z _ta _ Vater treatmr a �.s at ca:h or
<br /> Indmate scu c,x c iwKcating cause of yak_ other cf use,
<br /> Vent `oma bore holes rn soil, allow vclat_t:, e -on �of con-�zc.-.inant-s,
<br /> ,.. a. "„a the Case r , l w . Check one box only. Case E Whn Fe -s'` - incident is n.__.o ” re, _-in
<br /> .re is rano$ c :'- ecte�=- x_ t),,=.I ., =f ._ act-ion,
<br /> r and ,r al,'f. ,
<br /> � case type _ be, "Ground =VIENTS Use this space to elaborate on any,
<br /> Water". indicate ,.,_s-, only if one or -r,:r a ,.w.ir._p<_ or
<br /> domestic water wells >... > been affected, €t `Grc,,rnd Water" SIAWME - Sign he form ua he space provided,
<br /> designation does n_ Yr at affected water cannot be, or is not. -
<br /> used for r,z r that water wet I e, f3lSTETSC.
<br /> affected, W is t:Etr4. c;c„ type may change further if the fame is complend by the tack ewer .or his, re.t, ..r last Copy
<br /> teat, case _, .. rb
<br /> investigation, and forward the remaining a ;res intact to your, 11,o,al tank _ .... i�g ,ger ,
<br /> .
<br /> d �str_b -ion, �-
<br /> indicate the categury , ,<_., >c__b.,., the cui _t status c,
<br /> s _ the ti - 2 3egimm! QAtm Qali r Ccniz§ Board
<br /> Check. one, box cnnly. .,. . . >_>.,,. _rte,=__ he reAt_•e to the case ty-pes, For �. ,csl wealth Cfficer and Malty .4—d of. Su ;,—is-,ors or their deli ,-tee
<br /> eizam le, if r z,-=- type r ,srr. Stat_<_ should Mer _., - r op0si. _._c._ .9 =.v.,.i,f. _:t,ams,
<br /> to the status of the gwwA woo, >a.vz� or c?e -a�, as , pose t 4, ,,._.er, :espcnassb[e pa. ,
<br /> teat of roil. Deacripnmw of ;rad.a... `c ova:
<br /> No 000m "=a - No _ r hm been taken by responsible party " c, =rd -
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