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' . OCT 31 '97 12~07F'M DEQ i WVR ' P.3~5
<br />a7:.N ~rr:C~t~ ~
<br />- - /-fOVµ :t-:itS F ~
<br />Nvtifica~iorr~for~[:.l~nd~er~round Stora~e 7an~Cs 4.~~..°.y~°-~~
<br />.:~~~~~ ra: Ortaon D~partment of Environmcntai Quality sTaYe u=~ an~Y
<br />~ C. : ~•rmocc
<br />Underground Stora~e Tan~:~~P°ogram . '
<br />r.~J. $GZ 1 i60 , ~~~~x«~.~a
<br />Portland, Ore;on 9i20i ~ . - - - - _-- - --
<br />No~iiic~~+on it rcquired Sy Feacral 1~,. ler ~it undersraund unlq Ihal h~~e bcen 7. iepsie :an4~:
<br />tlS.[d lO f10~! ftjUl~ttd luoSUoCt7 I~nCi ~anuary I. 197t. ;}t,t ut in the;ro~nd ss ~. piFeiine f3C:lilie~ !i~cluCing S~therins linesl ~egvl]lQd unds[ th4 N~tueal Gis
<br />o11.Uy a, I4s6, er ~ha~ are 6rovEnl'~la use ~Nar ~N~Y S. 1986. The inform~~ian p~FZ!inr Saiery r.~; o~ 19bd, or ~he Mar~rdOUS .~a~~Q ~pei~ne 51ic:y dct oi
<br />:eq~dted ii rrquired SY Seaion "002 at thc Resourct Co~~ee~a~ion fnd Rxa~.ery ta;g, a~ `.,n~c~ is an t~uasia~e ~roeline iac~tuv ~egv~•~ed under S~ue ~a~~:
<br />r[:, IRC~A). as ~mend~d. 5. t~re1C' ~~++p0u~dments, pits, pondS. Or I,gvv~s:
<br />The pnm~ry7wFese o( t!~is nuifq~cen progr.tm it ro 1oC:~e i~d a~w~c v~dr- ~. tta~m wa~er o~ wasce w+ror,to~kcho~ ~~niena:
<br />;raund tanies ~h~c scare er h~ve sta~ed p«<elrum er n~:~~doys suSuanc:z II as
<br />fONd! w~il 'ot b~std a!t ~e75Cnablv ~h~lably
<br />n
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<br />t
<br />i
<br />ti
<br />h ~• ~~•tn~o~~rt p~oeHf ~i~ks:
<br />d. IiGuid -V~ps or ~fsoc~zttd gs~heti~y Gnt! ditrt~ly rtl~~KJ to e~l 0~ g~i
<br />yp
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<br />~q
<br />Orma
<br />~
<br />a
<br />tapet~6d :tiat t
<br />in ~ne~suten<e C! wch rrco~ds. yo~r knrn.~edge, hclief, a~ recoileccian.
<br />or
<br />tecorCS pioducaan ~nG ;othen++g opeeauon<:
<br />.
<br />.
<br />who ~{~s~ Noii~ 1 Sccuon yCd2 or RC2A. ~r ame~ded, req~,irtt ~ha~, vnl~s
<br />Y ~- scorag~ ~:nks v:vaied !++ ~n undergta~nC .va fiutn as ~ oasemant, cellu,
<br />ra~~ewerkSng d~iit, shah. w cunnell if ~ne s~o~age ta~k ~s s~tua[ed upon or abave
<br />excmaed. ownen of undergrovnC ~~nk~ ~hu per~ r;svlued ~ubst~~ccs mmi ~oa~y the svrl~ce of tlu loar.
<br />aa:iqnaud S~~u e~ loeal ~gr~ein of ~he ex~stencroi thei~ bnks_ L1.ner means,
<br />(ay in ~hn e~se ol ~n unde~ground smqge ~nk in use en NovemOcr J, 19a~, a~ •
<br />'Nhsi Su6sU~Ce> >~e Ca~erndt '~+e noai~csuon re,wr~~ne~~s ~pp(y to ~„dtr•
<br />`
<br />LrouQnt in~a use aner ihac aace. ~ny persan whe e.vn~ ~n underground sionge unk ;round ttange t~nks thac concain reg~la~ed tubs~~nttt. This ~~cluacs any subst:nce
<br />or dif0ensin; oi reruWled wbstances. and
<br />usr
<br />~sed ~or che scaage C~Mtd iS hi t~faOtiS ifl S2C[I00 101 l I il 0I Ufe Comprtnensivt Ef1~~rOnm~pt~1
<br />,
<br />,
<br />Ib! in i'~e ase o( anr under;rouna itange :ank !n vse belare npvembcr 6. 79ad,
<br />ly
<br />d lue~J Unk imm~diur
<br />AO Oy R~~PO^sc. Com~,e~s~t~on ano Li~b~lity A~: o! 19Aa IC:QC:AI. Mtth the ezce0tion oi
<br />lhefe )ueft]neCi rCY~itld ~7 h7Ll~UOU3 w~Hevnd2r iuEt~llt ~ e~ RC.v\. ll ilu7
<br />,
<br />vnc
<br />~u~ na lans:r i~ 4ie o~ Ihat d~te, iny re(so~ w
<br />beiert ~hr d~fc0~~~uat~an ol i~s usa. inelud~tt pQ.rols~m, e,y.. crvd~ Ou o~ ~~Y f~acio~ ~hercaf whicn ii liqu~d ~l ltane~~C
<br /> COAairionc oi ir~++aer~i~re ~~e prestv~e ~SD dcgrats F~h~enhe~c ~~~ 1 a.i yo~nds per
<br />Wh~( Ta~kt Ar~ l~t:vded2 undar~aund ttas~e eank is aanr.ed» anyene or com• sq~are ~~ch absolu~el.
<br />vinaaon o~ :~nks :hat (:) is uscd co ccntmo ~n u~.:muf.uon of "tagulated
<br />" ~Ad (21 w7Mi5! vd~me Gnc!ucins conneaed u~de~grOU~d piPns) iS
<br />svostanc:s ~yhcte Ta .`~od 1 Com le~d notdie~tienlermt ylw~k bt son~ to lhe addreS~ gtvcn
<br />~Y P
<br />.
<br />:0; ar mcra 6en~i<h :ha ;te~n~+. ;vm~ e: amplei ~re u~+d<rground Ianks s~aring: ~t Ihe top a! th~s page.
<br />i. yamlina.,,sed ari, o~ ~ies:l ~~el, :~01_ inc~scrisi sah~enis, pescicides, herb~eidr: ar w~ ~~ ro r,o~~rr? ~. O•Yne,s of u~de; grou~d sionQe :anks in uu ac ch:[ :~~vc 6ean
<br />I~rttisln/i• ~ t~ken oul O! opersci0n ~iter J~~~~ry I. :°,7~. buc ~~TI in.~nc ground. MuSt r.Ol~ty bY
<br />Wh~l Ti~ki Are sduded? Tanks remOv~d lrOm Ihc graurtd art not s~bjocl ~o ~Y 8, 1?86. 2. G~nCR ~+np b~~s VRdetsfOtrnd lio~~6e f~~ks in~o u5~ ~itqr ~Uy 0.
<br />no~~~~G~c:o~. Othe~ tlnks t.s<.uded lram nOtui<a~~0~ ~rc: 198b, rttu:t nCtify wi~hin IO diy5 O~ b~~g~ng Ih! tan~5 into vst.
<br />t. f~.m o~ rtsid~ntial ianks ef 1.100 $3UCn+ Gr I~i UPS<+~y use~ (or Tto~g ~otCr ac~iuiss: ~.ny owner who knowtn~lY fa(Is la noil(y a. eubmils :~IsE iniortrt~lion
<br />~4c1 [Of nOACOTT[fL'JI aurpCilS: ShSII Se SuI]je[t ~O s R~'il pCnallY nOt :o tzceed St0.0~ tor e~ch ~ank tar .•7~ieh
<br />2_ ~ankj u:Cd ~o~ 11oI~~$ helUAt oll (oe e0rtaumOllve uie oA :hd CremrSCi'wherr ~olilication i~ nee giren or fer wnieS false informaiiort is lubmi~lcd.
<br />~rored:
<br /> ~r ~
<br />Pte~se ~ype o~ D~~^~ ~^ ~^k olI ilems exetat ';s~gnature" in $ec~io~ ~/. T~is (orm mvit bt tompleltd Indita:e numher ef
<br />h
<br />i ~
<br />eece
<br />on s
<br />~or t_~h 10<~~~Q~ CO~tsinin~' undts5:ound stora5e tank~. If mort ih~n 5 ~~nks ~re owntd ot th~s loeution, continuat
<br />pnotoCepy thr rtvtne side, and sisple cantinuucian sheets io thiy lorm. .
<br />- - . ~lwChdd.
<br />~,.~.,~
<br />w
<br />p~~nCr N~m~ tCaperotion. IACividu.il. PUEIit r~.~~n[y. O~ O1~er Entityl
<br />Marion_.Countv ~
<br />Streec Addre~i
<br />100 Hi h Street NE, Salem, Oreqon
<br />Co~nly •
<br />Marion
<br />~;~y St~~e 2ip Cvde
<br />Salem, Orecton 97301 , _
<br />.~rca Cude Phonr tvum~er
<br />~~3-373-4424
<br />Typc o~ Owner (Ma~k ~I! tb~t apply ~t`.7)
<br />~ P.iv:ta or
<br />~ Cutrent ~~tste Or Loeal Gov't.
<br />Fede~ai Gov't. COrparate
<br />^ O+~neishia
<br />~ Fo~m~r (CrSA (seiliry I.Q. r•o.) ~ncerlarn
<br />tlf same us Section I, ma~ic box here^
<br />facility vame or Company Site ldentt~ier. :s ~ppllcsble
<br />Former Chevron Station
<br />Sueet ~edress or State fioad. as appf~c=ble "
<br />595 Eourt Street NE
<br />~Ounly
<br />Marion
<br />Cicy (nesrrstl ~ 5c;,te Z1pCode
<br />Salem, Oreqon
<br />Inditata nn~rk tSOx h~te'f t~nkfsl
<br />numbes ol ue locued on land w~ihl~ ^
<br />tanks at this 1 ~~ lndiar reservation
<br />lauc~on on othe~ I~ditn tru~t ~ands
<br />Namq (if Same ~S Settio~ 1, ma~k baz here~J ~ l06 7itlp Pnant Numbu
<br />Senior Env~ronmental Engineer '~~°`~31'6078 •
<br />, . .~
<br />Q Ma~~ box here only it this i: an ~mended a~~tubseqvenc noci~co~~on for ih7s lacadon.
<br />r.^.• ~i
<br />I certi'ry vnder penalry of la~v eha~ ~ I~ave personally e<amined and ~m lamiliar with the in~a~matio~ submilted in this ~nd ali attaChed
<br />dacume~ts, and ~hac based on my inquiry af those individvals immediately re~ponsible for obtaining che inlarmation. I believe ~hat the
<br />submicted iniormacion is true, accuta~e, ~nd comple~e _
<br />Y• .
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