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UAR/PROP 65_PRE 2019
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0502831
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
11/20/2024 9:22:03 AM
Creation date
11/4/2018 5:16:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0502831
PE
2381
FACILITY_ID
FA0005586
FACILITY_NAME
RON NUNAN CHEVRON
STREET_NUMBER
13336
Direction
E
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
APN
01902044
CURRENT_STATUS
02
SITE_LOCATION
13336 E HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\HWY 88\13336\PR0502831\UAR_PROP 65.PDF
Tags
EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> ❑YES NO REPORT BEEN FLED T OYES NO (HEREBY CERTIFY THAT I AM ADESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> REPORTED THIS INFORMATION TO LOCAL OFFICIALS PURSUANT TO SECTION 251307 OF <br /> RRE�PORTDATE CASE# THE HEAL IHA OSAFTY!COOD.E. <br /> VM M .1 V Y SIGNED IZ.� 1t✓�1�A.X -_A _ <br /> DAT <br /> NAME OF INDIVIDUAL FLING REPORT PHONE SIGNATURE <br /> L (7 al)91a� 3 + <br /> 9 REPRESENDNG O OWNEWOPERATOR O REGIONAL BOARD COMPANY OR AGENCY NAME <br /> ppc IA <br /> LOCAL AGENCY OTHER <br /> g ADDRESS [� SYxk.��•t C.4 95201 <br /> IllJL/I E. NI12tLTc�+a� f crtr STATE 2p <br /> NAME OONTACTPERSON PHONE <br /> m¢ Z E_] UNKNOWN JOHN 7t. (10j) - 7k <br /> <y ADDRESS <br /> 9 -P. O. SoX Q7 &TRELT I-zcKEPoR+�CKY � 95237 <br /> FACLITY NAME(F APPLICABLE) OPERATOR ap <br /> pHDNE <br /> r)OHN Z (209)'72-7- Ic2 <br /> tj ADDRESS <br /> x 1333(n E. NWy 83 I CEF+oap Sva icw4v(N 95237 <br /> w CROSSSTREET TYPE OF AREA 000MMERCIAL O INDUSTRIAL J�g RURAL TYPE OF BUSINESS IQI RETAIL FUEL STATION <br /> Hwy 12 O RESIDENTIAL OOTHER O FARM O OTHER <br /> g LOCALAGENCY AGENCY NAME CONTACTPERSON PHONE <br /> ELw (2u) (o£s 3513 <br /> 6K REGIONAL BOARD PHONE <br /> m (7) NAME OUANTTLY LOST(GALLONS) <br /> REGULA-R GRSOL)NGlc�= UNKNOWN <br /> m <br /> UNLSADt CGASOLtN� UNKNOWN <br /> k DATE DISCOVERED [) F DISCOVERED O INVENTORY CONTROL O SUBSURFACE MONITORING NUISANCE CO <br /> p- NDITIONS <br /> i M M 1 017 .1 u(� l <br /> Y 3 r lel TANK TEST O TANK REMOVAL O OTHER <br /> DATE DISCHARGE BEGAN p� METHOD USED TO STOP DISCHARGE(CHECK ALL TONT APPLY) <br /> w M�®D O r V.yf Y ❑ UNKNOWN O REMOVEOONTENTS O REPLACE TANK O CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED 4 ��y REPAIRTANK El REPAIRPFING ID CHANGEPROCEDURE <br /> p O YES �NO IFYES,DATE M M .1 .1 YJ Y p� OTHER Ijrkj)n(y]o <br /> u� SOURCE OF DISCHARGE TANKS ONLWCAPACITY MATERIAL CAUSE(S) <br /> O TANKLEAK <br /> O maUuINIK <br /> NOWN IQI QQ +�T.00M GAL. FIBERGLASS OVERFILL RUPTUREF <br /> ALURE <br /> PIPINGLEAK VeG1 +199 YS STEEL CORROSION UNKNOWN <br /> Oa <br /> OTHER P OTR <br /> • K <br /> O SPILL O OTHER <br /> yw CHECK O ONLY <br /> UNDETERMINED O SOILONLY O GROUNDWATER O DRINKINGWATER- (CHECK ONLY F WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECKONEONLY <br /> Z <br /> w¢P SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) O CLEANUP IN PROGRESSO SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> Utl1 ❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS O NO FUNDS AVALABLE RODE O EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> a <br /> O CAP SITE(CD) ❑ EXCAVATE&DISPOSE(ED) O REMOVE FREE PRODUCT(FP) O ENHANCED BIODEGRADATION(IT) <br /> O CONTAINMENT BARRIER(CB) O EXCAVATE&TREAT(ET) O PUMP&TREAT GROUNDWATER(GID O REPLACE SUPPLY IRS) <br /> O TREATMENT AT HOOKUP(HU) O NO ACTION REQUIRED INA) O OTHER(O'D <br /> K <br /> y We_ aw- wnUc-Avd ma.mq*- 6( stAt+n, .-1xL Will rau-&ouyTcN pc,,- Info, aYL. <br /> re(�tir5 -1 W, I( CACI 194Lk �rida� 2/1q/gs � vp4a-u- <br /> 2- $8 Tan k i i n veA+1 n -4o k- alp c kek+x)r lealkS 6 y 0w <br /> HSCO51<17) <br />
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