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• • APPENDIX C <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SI 11 <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY !'IV' <br /> YES ® NO REPORT BEEN FILED 7 ❑ YES ® NO I HEREBY CERTIFYTHATI.HAVE ISM18UTEDTHIS INFORMATION ACCORDING TO THE - (1 <br /> :77 <br /> B7 N SHEETON THE BACK PAf CF 4f15 �t 9J <br /> REPORT DATE CASE1 _ <br /> OJ 9 d id 9 d 9 d 4 r 94-118 R <br /> NAME OFINOIVDEALTHUALFILINGREPORT PHONE SIGNATURE PERMIT/SERVICE <br /> S <br /> m <br /> Charles J. Adkins ( 913)624-3481 <br /> w REPRESENTING ® OWNER/OPERATOR REGIONAL BOARD I COMPANY OR AGENCY NAME <br /> LOCAL AGENCY Q OTHER <br /> 8 <br /> ADDRESS <br /> 2330 Shawnee Mission Parkway Westwood KS 66205 <br /> srReer cm SIAM VP <br /> NAME OONTACTPERSON PHONE <br /> z� Sprint Communications Corp UNKNOWN Margaret Pitts X316• )854-5743 <br /> a <br /> IL ADDRESS <br /> Q6 901 East 104th Street Kansas City MO 64131 <br /> VAeET em VAI P <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> s Sprint Sprint ( 209) 941-0929 <br /> i ADDRESS <br /> 3807 Coronado Avenue Stockton San Joaquin 95204 <br /> W STREET CRY LdIMYap <br /> CROSS STREET <br /> N <br /> g LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> wW San Joaquin County Health Dept. Eric Trevina 1 (209 ) 468-3420 <br /> W REGIONAL 80ARD PHONE <br /> ` <br /> Central Valley Region 1 (916 ) 255-3000 <br /> u, (1) NAME QUANTITY LOST(GALLONS) <br /> nI Diesel Fuel //2 ® UNKNOWN <br /> �2 <br /> I � <br /> UNKNOWN <br /> i' DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL SUBSURFACEMONITORING NUISANCE CONDITIONS <br /> w0 d 9.1 1 d 2.1 94 Y E TANK TEST ® TANK REMOVAL OTHER <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> NI o r © UNKNOWN ®REMOVE CONTENTS ❑CLOSE TANK L REMOVE REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED T �REPAIR TANK CLOSE TANK&FU IN PI ACE CHANGE PROCEDURE <br /> Ivry <br /> a ® YES [�3 NO IF YES.DATE 0� 9u o2 <br /> f d 9 rl 4 r LJ REPLACE TANK OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ¢< TANK LEAK UNKNOWN OVERFILL flUPTURE/FAILUflE SPILL <br /> .G PIPING LEAK 0 OTHER CORROSION ® UNKNOWN OTHER <br /> ..I CHECKONEONLY <br /> O C UNDETERMINED © SOIL ONLY ❑ GROUNDWATER [:] DRINKING WATER•(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY I� <br /> w2 NO ACTON TAKEN � PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMIRED O POLLUTION CHARACTERIZATIONjy <br /> ® LEAK BEING TJ-CONFIRMED J PRELIMINARY SITE ASSESSMENT UNDERWAY O POS.CIEANUPMONITORINOINPROGRESS ' ^ <br /> O I REMEOIATIONPLAN C-3 CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UNDERWAY .LV <br /> CHECK APPRCPRIATE ACTION(S) ❑ EXCAVATE{DISPOSE(ED) C REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) \ <br /> ^ as Ab NP1mY; <br /> W4 I� LAP SITE(CA) EXCAVATE 8 TREAT(ET) =! PUMP A TREAT GROUNDWATER(GT)IREPLACE SUPPLY(RST <br /> w� C.^,NTAPIMENT BARRIER(C3) 77 NO ACTION REQUIRED INA) L TREATMENTATHOOKL'P(HU) L__� VENT SCIL(VS) ` <br /> VACUUM EXTRACT IVE) LXI OTHERmT) To Be Determined <br /> Preliminary indications are the release was minimal and no threat to groundwater v, <br /> or drinking water. <br /> C-1 `m" ° <br />