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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES Kt7F1`LtYC.At.JLGENCY lISE 3Ni'-Y" <br /> R€PORTSEEN FILED? IHEpLBYO tt'gf" i'HATIAM A.LS.L$YC�NA't DGGW 47NMi?NYEMPWYE AND YHAT <br /> p YES ® NO ®)ES p No (?AYL#taDprE#S:YHIS fdPOS3MA3halJ rL?LDGALNiIALS P Rsl ANT ro SEcr,oN <br /> ;XN$I701~YM�#IEffLTN ANDSA�'E'(Y COOE iia <br /> REPORT DATE(MM-0D-Y1� CASE# "s g <br /> 17312 <br /> 06/07/91 . ....o>..fn..�.'�.': <br /> NAME OF INDIVIDUAL FIUNG REPORT PHONE SIGNATURE <br /> m Elaine Lavine (415)-571-2482 <br /> 0 REPRESENTING OOWNSNOPERATOR pREGSONAL BOARD COMPANY OR AGENCY NAME <br /> ¢O prOCALAGENCY [�OTHER ARCO Products Company <br /> ADDRESS P.O.Box 5811 San Mateo CA 944M <br /> STREET CITY STATE aP <br /> NAME CONTACT PERSON PHONE <br /> N ARCO Products Company ❑LNKNowN Elaine J.Lavine 415)-571-2482I <br /> 0 ADDRESS PO BOX 5811 ATTN: Env.Compl.DepL San Mateo C4 94402 <br /> STREET CITY STATE ZP <br /> FACILITY NAME OF APPUCABLE) OPERATOR PHONE <br /> z ARCO FACILITY 04493 JOHN H ITI'NER (209)-948-0838 <br /> V ADDRESS 205 N.CENTER ST STOCKTON SAN JOAQUIN 95202 <br /> 0 STREET CITY COUNTY zP <br /> CROSS STREET <br /> y CHANNEL/N CENTER ST <br /> z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w SAN JOAQUIN COUNTY PUBLIC HEALTH DOUG WILSON (209)-468-3420 <br /> REGIONAL BOARD PHONE <br /> CENTRAL VALLEY REGION LEE BOGGS (916)-361-5600 <br /> N (�) NAME OLW rnTY LOST(GALLONS) <br /> GASOLINE [:3 UNKNOWN <br /> ,p m QUANTITY LOST(GALLONS) <br /> j Z <br /> [:]UNKNOWN <br /> N <br /> DATE DISCOVERED(MM-DD-YY) HOWDISCOVERED ❑MENTORY CONTROL ❑SUBSURFACE MONITORING QNUISANCE CONDITIONS 06031991 pTANK TEST pTANCPEMOVAL ®OTHER DRIVE OFF <br /> H< DATE DISCHARGE BEGAN(MM-DD-YY) METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> 06/03/1991 LD-NKNOWN ❑ REMOVE CONTENTS ❑ REPLACE TANK QCLOSE TANK <br /> H4501SCHARGE BEEN STOPPED? ❑REPAIR TANK ❑ REPAIR PIPING [_]CHANGE PROCEDURE <br /> a]YES pNO IFYES,DATE 06/03/1991 pX OTHER SHUT OFF PUMP <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ¢N OTAN(LEAK p UNKNOWN p OVERRLL pFiPIURE/FAILURE SPILL <br /> 801 pPPNG LEAK ® OTHER ❑ CORROSION [_] UNKNOWN ®OTHER DRIVE OFF <br /> w wa CHECK ONE ONLY <br /> pF ®UNDETERMINED E3 SOL ONLY ❑GROUNDWATER ❑DFN04GWATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> p ❑NO ACTION TAKEN 0 PREUNTYAPY SITE ASSESSMENT WORKPLAN SUBMITTED ❑POLLUTION CHARACTERIZATION <br /> j p LEAK BEING CONFIRMED p PRELIMINARY SITE ASSESSMENT UNDERWAY p POST CLEANUP MONITORING IN PROGRESS <br /> O w ❑ REMEDIATION PLAN EX] CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION($) [::]EVACUATE AND DISPOSE(ED) ❑RaETAOJE FREE PRODUCT(FP) pENHANCED BIO DEGRADATION OT) <br /> o p CAP SITE(CD) ❑EVACUATE AND TREAT(ET) p RAP&TREAT GROUNDWATER(GT) p REPLACE SUPPLY(RS) <br /> wr <br /> a ❑CONTAINMENT BARRIER(CB) M NOACTION REQUIRED(NA) p TREATMENTAT HOOKUP(HU) ❑VENTSUPPLY(VS) <br /> p VACUUM EXTRACT(VE) ❑OTHER(OT) <br /> 12 CUSTOMER DROVE OFF WITH NOZZLE IN CAR. SPILL CLEANED UP WITH ABSORBENT. PUMP REPAIRED. <br /> z <br /> SAN JOAQUIN COUNTY AND OES NOTIFIED. <br /> s <br /> O <br /> U <br />