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UAR/PROP 65_PRE 2019
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0504298
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
4/1/2020 11:52:59 AM
Creation date
11/2/2018 4:45:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0504298
PE
2381
FACILITY_ID
FA0006156
FACILITY_NAME
PURE GRO/BREA*
STREET_NUMBER
1904
Direction
W
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16302041
CURRENT_STATUS
02
SITE_LOCATION
1904 W CHARTER WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\C\CHARTER\1904\PR0504298\UAR_PROP 65.PDF
Tags
EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERV/ICES FOR LOCAL AGENCY USE ONLYEMPLOYEE AND THAT I <br /> YES REPORT BEEN FLED? OYES Ip7 NO REEPORTED TH 5 NFORMATIONREBY CERTIFY THAT I AMA 0 SLOCAL OF IC ALSN PURSUANT TO SECTION 25180.7 A <br /> O 0F <br /> ISI THE HEALT},�AyyNDSAFfY CODE L ,_ '.--- ��._ <br /> CASES '? <br /> REPORT DATE <br /> DA <br /> �1 7`fi' F .i�,�• TE <br /> 0. 3. O V SIGNED <br /> SIGNATURE "} <br /> NAME OF 11 FLING PHONE RT (�� <br /> c des 6,- ur✓� 5 UAV Tl(i <br /> m O <br /> o REPRESENTING O OWNEWOPERATOR REGIONAL BOARD COMPANY OR AGENCY NAME <br /> r7 <br /> {V <br /> O LOCAL AGENCY O OTHER <br /> ADDRESS <br /> I Orf � PERSON�'hrwrkr( N ON CcrG o Nrc� ATE 206 P <br /> CONTACT PHONE <br /> NAME c2o91 y6d Zoe!( <br /> �ffig M 0 UNW40M <br /> X< ADDRESS <br /> 8� �4o1 cm (r STATE D6 P <br /> OPERATOR PHONE <br /> FACILITY NAME IF APPLICABLE) ,2^ ) <br /> Gro GUS (([)'( <br /> ADDRESS CITY <br /> ' St(✓ 9u�T'•' �S�Ob <br /> CROSS STREET TYPE OF AREA COMMERCIAL Q INDUSTRIAL RURAL TYPE OF BUSINESS RETAIL FUEL STATION <br /> aS Q RESDENTNL I]OTHER 0 FARM W OTHER <br /> U <br /> LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> q { p�Ne rADso+� ate ) GS'NW <br /> i SQ✓v (� UW GolCK NCG <br /> PHONE <br /> REGIONAL BOARD <br /> �RWQ� (}otdeni Rld 3s/5'7�Jo <br /> m (T) NAME <br /> QUANTITYLOST 7UNKNOWN -- <br /> �5 /O�LAelA72. <br /> lSdeSe� rLA � UNKNOWN <br /> OMOJM R0. ` 0 & V ��S ARE ST n ,INyENREMOVACONTROL OTHER -*4 O NUL4ANCE COPDITON3 <br /> S DATE DISCHARGE BEGAN „u/ METHOD USED TO STOP DISCHARGE(CHECK ALL T/ATM Y) <br /> Y' UNKNOWN O REMOVECON(ENTS O REPLACE TANK OSE TANK <br /> w M M o v Y REPAIRTANK REPAIRPIPINO CHANCE PROCEDURE <br /> HAS DI HARGE BEEN STOPPED 7 <br /> p VES [:] NO FVES,DATE M �D Y V D OTHER <br /> xzz��Wy((II SOURCE OF DISCHARGE TANKS LYCAP ITY MATERIAL CAUSE(S) <br /> O TANK LEAK UNKNOWNPOV GAL, O FIBERGLASS O OVERFLLUPNREIFALURE <br /> O PIPING LEAK AGE_ YRS V STEEL CORROSION UNKNOWN <br /> O OTHER O UNKNOWN O OTHER O SPILL O OTHER <br /> yw� CHECK EONLV <br /> KZ� UNDETERMINED O SOILONLY O GROUNDWATER O DRINKING WATER- (CHECK ONLY F WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> QQ O SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEW O CLEANUP IN PROGRESSO SIGNED OFF(CLEANUP COMPLETEDOR UNNECESSARY) <br /> S� O NOACTIONTAKEN Q POST CLEANUP MONITORING IN PROGRESS O NO FUNDS AVAILABLE TO PROCEED O EVALUATINGCLEANIIPALTERNATNES <br /> CHECK APPROPRIATE ACTON(S)(SEE BACK FOR DETAILS) <br /> O CAP SITE(CD) O EXCAVATE&DISPOSE(ED) O REMOVE FREE PRODUCT(FP) O ENHANCED SO DEGRADATION(IT) <br /> 2y O CONTAINMENT BARRIER(CB) O EXCAVATE&TREAT(ET) O PUMP&TREAT GROUNDWATER(GT) O REPLACE SUPPLY IRS) <br /> O TREATMENT AT HOOKUP(HU) O NO ACTION REQUIRED INA) O OTHER(OT) <br /> � �P rO 1 ���-�-e� 1'�-s U i s�ent mru� �-- re y u i re c� ,b �t -f'!� <br />
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