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UAR/PROP 65_PRE 2019
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0504159
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
11/20/2024 9:08:29 AM
Creation date
11/5/2018 10:36:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0504159
PE
2381
FACILITY_ID
FA0002896
FACILITY_NAME
PETES PLACE LLC
STREET_NUMBER
9355
Direction
W
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95206
APN
13109021
CURRENT_STATUS
02
SITE_LOCATION
9355 W HWY 4
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\F\HWY 4\9355\PR0504159\UAR_PROP 65.PDF
Tags
EHD - Public
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q1-LL, <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/ CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVI S FOR LOCAL AGENCY USE ONLY <br /> REPORTBEENFILED4 ;mi <br /> ERpFYTHATI HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> F-1 YES NO ❑YES NO ONSHO N T�U`. 1--EET ON THE BACK PAGE OF THIS FORM <br /> PORT.DATE r CASES _a <br /> DATE/!!! DATE <br /> E OF INDIVD, U�FILING EP RT PHONE SI TU <br /> Ctrn <br /> VIP <br /> 209>q'6 <br /> w REPRES TING ❑ OWNER^OPERATOR ❑ REGIONAL18GARD COMPANY <br /> L1ORRAGENCY NAME <br /> }`�I <br /> x LOCAL AGENCY ❑ OTHER P 11 �J E7 ' 1) <br /> ADDRESS �_ <br /> N 0n l//V El J cm 1 D I' (//Is Are (�tnvJ <br /> &REE <br /> w Z a <br /> NAME <br /> y CONTACT PERSON PHONE <br /> \ ) �Y � � I`n <br /> 5Whe4UNKNOWN } <br /> wQADDRW35 SC95Zo(o <br /> � <br /> ONE <br /> FACILITY NAME SIF APPL L �� T PH ) <br /> O S <br /> a ADDRESS <br /> OKK <br /> cm ap <br /> w <br /> m CflOSS STREET <br /> LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> �w <br /> w REGIONAL BOARD (HONE ) <br /> w (�) NAME QUANTITY LOST(GAEv <br /> UNKNOWN <br /> H <br /> �Rz m <br /> m ❑ UNKNOWN <br /> i DATE DISCOVERED A q HOW DISCOVERED ❑ VENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> u Lo lr ' r ❑ TANK TEST TANK REMOVAL ❑ OTHER <br /> mDATE DISCHARGE BEGAN METHOD USEDTO STOP DISCHApffE(CHECK ALL THAT APPLY) <br /> UNKNOWN REMOVE CONTENTS CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> w u o v r <br /> p HAS DISC RGE BEEN STOPPED T �7 O REPAIR TANK CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> 0 YES ❑ NO IFYES,DATE 5 (2D Y ' Y ❑REPLACE TANK OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) I-1 �',/ <br /> F-] TANK LEAK UNKNOWN ❑ OVERFILL 1 r7ye'TURE/FAILURE ❑ SPILL <br /> y ❑ PIPING LEAK ❑ OTHER ❑ CORROSION I`1—VY/UNKNOWN Q OTHER <br /> w w CHECK ONE ONLY <br /> O ❑ UNDETERMINED ❑ SOIL ONLY GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> -tee�+ ❑ NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> jy F-1LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY O POST CLEANUP MONITORING IN PROGRESS <br /> O REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) E:] CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BID DEGRADATION(IT) <br /> �sw ranoa*..m <br /> 00 ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) PUMP&TREAT GROUNDWATER(GT) REPLACE SUPPLY IRS) <br /> ~ ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED INA) ❑ TREATMENT AT HOOKUP(HUI ❑ VENTSOIL(VS) <br /> wa <br /> ❑ VACUUM EXTRACT(VE) ❑ OTHER(OT) <br /> -- 60i SC�vn# <br /> GvvQ°�✓GZt l+1//1 4e /ILS k&/wt:v?- <br /> 8ylin� L'�7�iI11e�zcc�i c� Cf S r�G�2r.�+c� (1Gf 9� C l' <br /> �(A <br />
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