My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
UAR/PROP 65_PRE 2019
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
D
>
DIAMOND
>
1050
>
2300 - Underground Storage Tank Program
>
PR0231781
>
UAR/PROP 65_PRE 2019
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
2/14/2020 11:16:19 AM
Creation date
11/4/2018 3:02:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0231781
PE
2381
FACILITY_ID
FA0001100
FACILITY_NAME
DIAMOND OF CALIFORNIA
STREET_NUMBER
1050
STREET_NAME
DIAMOND
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15532019
CURRENT_STATUS
02
SITE_LOCATION
1050 DIAMOND ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\D\DIAMOND\1050\PR0231781\UAR_PROP 65.PDF
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> / REPORT BEEN FILED T1 HEREBY CERTIFY THAT 1 AM A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> ❑YES �/Ic0 [::]YES ❑ NO REPORTED THIS INFORMATION TO LOCAL OFFICIALS PURSUANT TO SECTION 25180.7 OF <br /> REPORTDATE �j CASE# THE HEALTH AND01 <br /> M (�v v SIGNED yT DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE <br /> � <br /> &L OZ c - z z� -� <br /> REPRESENTING ❑ OWIrR/OPERATOR ❑ REGIONALBOARD COMPANY OR AGENCY NAME <br /> 0 LFS"^'^'AGENCY ❑ OTHER <br /> ADDRESS <br /> • STREET �L�V GfY V •��� S ATE ZIP <br /> NAME CONTACTPERSON// PHONE 0i /,-WoA D ❑ UNKNOWN l 7w7-low <br /> a ADDRESS <br /> ¢ /✓v v STREU V , /T*aA IJ cm �� WATE ( zip <br /> FACLITY NAME IF APPLICABLE) OPERATOR PHONE <br /> v <br /> a ADDRESS <br /> �2 ap <br /> y CROSS STREET TYPE OF AREA MERCIAL❑INDUSTRIAL❑RURAL TYPE OF BUSINESS RETAIL FUEL STATION <br /> j ❑RESIDENTIAL ❑OTHER ❑ FARMTHER <br /> LOCALAGENCY AGENCY NAME CONTACTPERSON PHONE <br /> i <br /> REGIONAL BOARD A A n PHONE <br /> (1) NAME QUANTITY LOST(GALLONS) <br /> / a rAx.r"-C41WU*-� [L-�NIDWN <br /> wl .� Ep/NKNOWN <br /> DATED) FI HO DISCOVERED ❑ INVENTORY CONTROL SUBSURFACE MONITORNG ❑ NUISANCE CONDITIONS <br /> 1 M • D D v v [--] TANK TEST F-1TAWREMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN , METHOD USED TO STOP DISCHARGE(CHECK ALL THATAPPLY) <br /> w M M o o v v =I U"N 1OWN ❑ REMOVE CONTENTS ❑ REPLACETANK ❑ CLOSE TANK <br /> Q HAS DISCHARGE BEEN STOPPED <br /> TOPPE07 ❑,, R/ETHP/EIIR TANK ❑ REPAIR PPNG ❑ CHANGEPROCEDURE <br /> p E] YES ❑/IPD YES,DATE M M o o v Y [j2ypR <br /> SOURCE OF DISCHARGE TANKS ONLYCAPACITY MATERIAL CAUSE(S) <br /> E::] TANK LEAK NOWN ��V` SUUch�AL, ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTUREIFALURE <br /> a ❑ PIPINGLEAK AGE YRS ❑ STEEL �,. ❑ CORROSION [UNKNOWN <br /> ❑ OTHER UNKNOWN Q O /� <br /> THER L- wcm/c ❑ SPILL ❑ OTHER <br /> ww CHECKONEONLY <br /> n <br /> o it ❑ UNDETERMINED3011 ONLY ❑ GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> FV� CHECK ONE ONLY <br /> wK ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROSLM ❑ CLEANUP IN PROGRESS SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> U% ❑ NOACTIONTAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED /EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> o ❑ CAP SITE(CD) ❑ EXCAVATEB DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATEB TREAT(ET) PU BTREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) <br /> ❑ TREATMENT AT HOOKUP(HU) ❑ NO ACTION REQUIRED INA) OTHER(OT) <br /> saB�,5- <�v/ <br /> wt 'go <br /> � <br /> � srf� •�ssrne <br /> NSCnS(�) <br />
The URL can be used to link to this page
Your browser does not support the video tag.