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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> YES ® NO REPORT BEEN FLED? HEREBY CERTIFY THAT I AM E::]YES ® NO .REPORTED THS NFORMATIONATO DESIGNATED <br /> OFFICIALSPMENT EMPLOYEE AND THAT I HAVE <br /> URSUANTURSUANT TO SECTION 25,801 OF <br /> REPORTDATE CASE# THE HEALTH AND SAFFY CODE. <br /> 0.1 5 ml 2 5 .18 YJ 8 Y .SIGNED --_- —!` -_— DATE. <br /> NAME OF INDIVIDUAL FILING REPORT PHONE IGNATURE <br /> > W.A. HASTINGS (209)948-2500 -- <br /> m _ <br /> REPRESENTING ® OWNEWOPERATOR Q REGIONAL BOARD COMPANY OR AGENCY NAME <br /> a LOCALAGENCY OTHER J.P. SERVICES, INC. _ <br /> ADDRESS g <br /> 175 INDUSTRIALB WAY BENICIA CA <br /> WY E <br /> NAME CMTACTPER80N PHONE <br /> aBERTRAM F. MAURER ❑ UNKNOWN SAME (209)948-8878 <br /> i ADDRESS <br /> 1105 CAMERON WAY sTREL STg�KTON 95287 <br /> FACILITY NAME IF APPLICABLE) OPEMTOR PHONE <br /> N/A SAME ( ) <br /> ADDRESS <br /> E. ACAWA RD. ACWPO SAN JOUJ4N <br /> y CROSSSTREET TYPE OF AREAE]COMMERCIAL Q INDUSTRIAL ®RURAL TYPE OF BUSINESS O RETAIL FUEL STATION <br /> S B 99 Q RESIDENTIAL 0 OTHER FARM 0 OTHER <br /> LOCALAGENCY AGENCY NAME CONTACTPERSON PHONE <br /> Fh <br /> w (209)46,9-3420 <br /> ww REGIONAL BOARD PHONE <br /> n <br /> UNKNOWN ( ) <br /> (i) NAME OUANTOY LOST(GALLONS) <br /> GASOLINE UNKNOWN <br /> of m <br /> 0 UNKNOWN <br /> i DATE DISCOVERED HOWDISCOVERED O INVENTORY CONTROL Q SUBSURFACE MONITORING Q NUISANCE CONDITIONS <br /> 0 M 5 M 2,1 5 0 8y $ y 0 TANKTEST � TANK REMOVAL OTHER <br /> DATE DISCHARGE BEGAN �Tyyyy METHOD USED TO STOP DISCHARGE(CHECK ALL THATAPPLY) <br /> w u M p p y y Eg UNKNOWN ® REMOVECONTENTS REPLACETANK CLOSE TANK <br /> p HAS DISCHARGE BEEN STOPPED 7 E:] REPAIRTANK REPAIRPIPIIG E] CHANGE PROCEDURE <br /> Ojff <br /> YES NO IFYES,DTE M M o o Y OTHER <br /> y SOURCE OF DISCHARGE TANKS ONLYA:APACITY MATERIAL CAUSE(S) <br /> TANKLEAK O UNKNOWN 550 GAL. E::] FIBERGLASS D OVERFILL O RUPTURErFAILURE <br /> 2 ❑ PIPINGLEAK AGE YRS M STEEL CORROSION ❑ UNKNOWN <br /> 2 0 OTHER ® UNKNOWN Q OTHER 0 SPILL Q OTHER <br /> W CHECKONEONLY <br /> d UNDETERMINED 0 SOILONLY O GROUNDWATER E] DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECKONEONLY <br /> w <br /> xt SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) F-� CLEANUP IN PROGRESSQ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> V� NO ACTION TAKEN O POST CLEANUP MONITORING IN PROGRESS NO FUNDS AVAILABLE TO PROCEED E-] EVALUATINGCLEANuPALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> CAPSITE(CD) ❑ EXCAVATE 6 DISPOSE(ED) 0 REMOVE FREE PRODUCT(FP) ENHANCED BIO DEGRADATION(IT) <br /> O CONTAINMENT BARRIER(CS) O EXCAVATE 6 TREAT(ET) PUNI TREAT GROUNDWATER(GT) 0 REPLACE SUPPLY(AS) <br /> O TREATMENT AT HOOKUP(HUI 0 NO ACTION REQUIRED INA) Q OTHER(OT) <br /> TANKS DRAINED APPROXIMATELY 6 (six) YEARS AGO, PER OWNER. <br /> DATE OF DISCOVERY IS DATE REPORTING PERSON DISCOVERED RELEASE. <br /> HSC W(4W, <br />