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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) l CONTAMINATION SITE REPORT <br />EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br />[] YES REPORT BEEN FILED 7 YES Q NO <br />:FOR LOCAL AGENCY. USE ONLY <br />A. I <br />SOCAL p0 <br />:pEEREBY �p7En THi NFORMAT" 0 . FICIALSN URSUANT SECTION 251807 OF <br />iHEH SAFTYCODE <br />REPORT DATE <br />CASES <br />DAT. <br />NAME OF INDIVIDUAL FILING REPORT <br />PHONE <br />SK3NATU <br />1(200AkO-3f�z2, <br />m <br />0 <br />AEP SENTI F-1 OWNER/OPERATOR Q REGIONAL BOARD <br />COMPANY OR AGENCY NAME <br />0 <br />OCALAGENCY OTHER <br />R411G <br />ffi <br />ADDRESS <br />� <br />T P -y/A� 6 STREET Cm L STATE O r <br />NAME <br />C I ACT PERSON 11 <br />$ J~ <br />/ % . UNKNOWN <br />r <br />r/ } �' <br />rPHOONNEE � �j <br />( LY//) NK � V60 <br />a <br />R a <br />cY7 3� <br />ADDRESScc <br />Lu <br />/3552-57 STREET CR'Y •� STATE l./J 21P <br />FACILITY NAME (IF APPLICABLE) <br />OPERATOR I, <br />PHONE <br />II <br />Q <br />q <br />ADDRESS <br />r <br />.1?3& /% STREET �S w CRY �I <br />�[�.f! COUNTY pp <br />CROSS STREET <br />TYPE OF AREA O COMMERCIALE] INDUSTRIAL URAL <br />TYPE OF BUSINESS RETAIL FUELS7ATION <br />RESIDENTIAL 0 OTHER i�. <br />� FARM �'6�T1 ER <br />ry <br />LOCAL AGENCY AGENCY NAME <br />CONTACT PERSON I� �, <br />PHONE <br />Z <br />�>� v� <br />,�3iLG .S✓ri <br />z� <br />wW <br />a <br />REGIONAL 130ARD <br />�i <br />y <br />PHONE <br />W&)34,s6-110v <br />(�) NAME ! QUANTITY LOST (GALLONS) <br />INOWN <br />- <br />I UNKNOWN <br />z <br />DATEDISCOVERED <br />HOW DISCOVERED F-1INVE RY CONTROL 3 SUBSURFACE MONITORING NUISANCE CONDITIONS <br />q <br />0mOTHER <br />"M r% Mj -`o !o d r / Y <br />C� TANK TEST ANKREMOVAL I <br />DATE DISCHARGE BEGAN <br />METHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) <br />�j KNOWN <br />M M D D Y Y <br />E] REMOVE CONTENTS D REPLACE TANK CLOSE TANK <br />W <br />REPAIR TANK i1 E] REPAIR PIPING CHANGE PROCEDURE <br />HAS DISCHA E SEEN STOPPED 7 <br />o <br />YES D NO IF YES, DATE M M o D v v <br />OTHER I? <br />Lu U) <br />SOURCE OF DISCHARGE <br />TANKLEAK �UKNOWN <br />TANKS ONLYrAPACITY MATERIAL i <br />,UGAL. FIBERGAS;'Q <br />CAUSE(S) <br />OVERFILL Q RUPTUREIFAILURE <br />PIPING LEAK <br />AGE YRS L !j <br />CORROSION �NOWN <br />El OTHER <br />UNKNOWN 0 OTHER I� <br />SPILL a OTHER <br />CHECK ONE ONLY <br />UNpETERMINEO90ILONLY GROUNDWATER [7] DRINKING WATER �� (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br />CHECK ONE ONLY i <br />w a <br />F <br />S1 INVESTIGATION IN PROGRESS (DEFINING EXTENT OF PROBLEM) F-1CLEANUPIN PROGRI-SS SIGNED OFF (CLEANUP COMPLETED OR UNNECESSARY) <br />0 <br />NO ACTION TAKEN E::] POST CLEANUP MONITORING IN PROGRESS Q NO FUNDS AVAILABLE TO PROCEED E] EVALUATING CLEANUP ALTERNATIVES <br />CHECK APPROPRIATE ACTION(S) (SEE BACK FOR DETAILS) <br />ozO <br />❑ CAP SITE (CD) E:1 EXCAVATE 3 DISPOSE (ED) REMOVE FREE PRODUCT (FP) Ej ENHANCED BIO DEGRADATION (IT) <br />wO <br />CONTAINMENT BARRIER (CS) 0 EXCAVATE 6 TREAT (ET) PUMP & TREAT GROUNDWATER (GT) REPLACE SUPPLY (RS) <br />¢li <br />F] TREATMENT AT HOOKUP (HU) NO ACTION REQUIRED (NA) OTHER (OT)���}� <br />z <br />,fid 7"a <br />U <br />NSD Os 144n <br />