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UAR/PROP 65_PRE 2019
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231036
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
10/3/2022 1:58:20 PM
Creation date
11/2/2018 3:47:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0231036
PE
2361
FACILITY_ID
FA0003761
FACILITY_NAME
ST JOSEPHS HOSPITAL
STREET_NUMBER
1800
Direction
N
STREET_NAME
CALIFORNIA
STREET_TYPE
ST
City
STOCKTON
Zip
95204
APN
12718044
CURRENT_STATUS
01
SITE_LOCATION
1800 N CALIFORNIA ST
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\C\CALIFORNIA\1800\PR0231036\UAR_ PROP 65.PDF
Tags
EHD - Public
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.,,, 4-- W a- <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)I CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY t. <br /> REPORT BEEN FILED T1HEREBY CERnFYTHATI HAVEDISTRIBUTED THIS INFORMATION ACCORDINGTOTHE <br /> OYES U NO Q YES NO <br /> REPORT DATE <br /> DISTRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM <br /> CASE <br /> INSTRUCTIONM M Y SIGNED DATE.. <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATU <br /> w REPRESENTING O OWNER/OPERATOR Q REGIONAL BOARD COMPANYORAGENCYN <br /> SL11 LOCAL AGENCY O OTHER LA)N <br /> a ADDRESS / <br /> OCm C STATE zIP�SZ L <br /> J NAME CONTACT PER ON PHONE <br /> Q UNKNOWNM e r ( '9 ) �(6 - <br /> UQ q <br /> u u ADDRESS /SZ j <br /> N � <br /> 2 h� <br /> � CITY � � STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) / OPERATOR PHONE �/ <br /> o <br /> a ADDRESS 1 <br /> w <br /> CROSS STREET <br /> O LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> 14 <br /> www REGIONAL BOARD PHONE <br /> O O <br /> as ( ) <br /> s <br /> NAME QUANTITY LOST fGALLONS <br /> UNKNOWN ( <br /> U W <br /> Q� <br /> m 2 T2) <br /> H O UNKNOWN <br /> i DATE DISCOVERED�j HOW DISCOVERED F INVENTORY CONTROL SUBSURFACE MONITORING O NUISANCECONDITIONS <br /> M M Q r r TANK TEST 0 TANK REMOVAL OTHER <br /> mDATE DISCHARGE BEGGAAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> ¢ I M v o Q r r UNKNOWN O REMOVE CONTENTS O CLOSE TANK 8 REMOVE REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED 7 O REPAIR TANK 0 CLOSE TANK&FILL IN PLACE O CHANGE PROCEDURE <br /> o O <br /> YESE] NO IF YES,DATE <br /> .1 I W DI DI Yl Y O REPLACE TANK O OTHER <br /> ,-a SOURCE OF DISCHARGE CAUSE(S) <br /> ¢j a TAN AK O UNKNOWN O OVERFILL RUPNRE/FAILURE SPILL <br /> 10/+O PIPING LEAK O OTHER F CORROSION 0 UNKNOWN O OTHER <br /> Iwa CHECK ONE ONLY <br /> O UNDETERMINED SOIL ONLY E GROUNDWATER 0 DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> w� NOACTIONTAKEN fPfiLIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED O POLLUTION CHARACTERIZATION <br /> my O LEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY O POST CLEANUP MONITORING IN PROGRESS <br /> O F--j REMEDIATION PLAN 0 CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) O CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTIONS) XCAVATE&DISPOSE(ED) REMOVE FREE PRODUCT(FP) 0 ENHANCED BIO DEGRADATION(IT) <br /> � 1�B,LK KA OET.V81 <br /> < <br /> 6O z F CAP SITE(CD) O EXCAVATE 8 TREAT(ET) PUMP 8 TREAT GROUNDWATER(GT)O REPLACE SUPPLY(RS) <br /> WF <br /> 60 O CONTAINMENT BARRIER(CB) NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) O VENT SOIL(VS) <br /> VACUUM EXTRACT(VE) O OTHER(OT) <br /> o �-e Wan-dL �r.�r,, �� Lc(nn�•_`7 �-�y G /l�u.�� <br /> Hsc mlA'9N <br />
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