MO-1360_0_CA_UST-61_19960614_24-Hour Reporting Form

24-HOUR REPORT
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yOCATSON OF TANK
(and/at xame of Site and ADDX
TAn 0WjMR/OPERATOR
&DDRES S� G � L F I`11
CITY OGKr- --/ LLzLF-
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CITY C �� L 0 I ?C .
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, line, dispehaers spills overfill) (35-4) 371_ ')
�RJ►TURE CF RELF.AS (t
� C AMOUNT LOST
Ty'pE OF PRODUCT RELEASED
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aATE OF RELEASE - /---�
19 DATE RELEASE DISCOVERED .,.._/.��19—
SUSPECTED RELEASE Tee 110 If Tes, explain
CONFIRMD RELEASE Yes p0 If Yes, explain
WATER SUPPLY IN AREA bow �y - distance
wells p0
city/county Yea
ROTE: 7. tF SUSPECTED RELEASE FOLLOW 250.52
a. system
b. site check
_ IF CONFIRMED RELEASE FOLLOW 280.61-280.63
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TZ"Co REPORTING RZL WE
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INFORMATION RECEIVED