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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)I CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES 'FO OCAL AGENCY USE ONLY <br /> ❑ YES NO REPORT BEEN FILED 7 ❑YES EA NO I HER BY CERTIFY T AT I AM.A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> rRE ED THIS IN TI TO LOCAL OFFICIALS PURSUANT TO SECTION 25180.7 OF <br /> REPORTDATE CASEa THEH AND <br /> M 1 7 8 v 8 <br /> --F <br /> SIGNED "..-- <br /> NAME OF INDIVIDUAL FILING REPORT PHONE MQNATURF <br /> Diane M. Hinson ( 209) 468-3441 <br /> REPRESENTING ❑ OWNEIVOPERATOR F-1FEGIONALBOARD COMPANY OR AGENCY NAME - _ - - <br /> ]x LOCALAGENCY ❑ OTHER San Joaquin Local Health District <br /> ADDRESS <br /> 1601 E. Hazelton Avenue , Stockton nATECA 95205 <br /> NAME CONTACT PERSON PHONE <br /> Continential Grain Company E] UNKNOWN Bob Lenhart 603 ) 228-9222 <br /> If ADDRESS <br /> 200 MEE< Market Bldg-Suite 1050 Cm Portland Oregon 97201 <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHOS <br /> Continential Grain Company same ( 2090 466-1850 <br /> ADDRESS <br /> 1805 STFEE R. Harbor Drive Atockton San Joaquin 95203 <br /> y CROSSSTREET TYPE OF AREA ❑COMMERCIAL Q INDUSTRIAL ❑RURAL TYPE OF BUSINESS ❑ RETAIL FUEL STATION <br /> Washin ton E:]RESIDENTIAL ❑OTHER ❑ FARM ® OTHER grain term_ <br /> 2 LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w San Joaquin Local Health District Diane M. Hinson ( 209)468-3441 <br /> w REGIONAL BOARD <br /> n PHONE <br /> Central Valley Sacramento A. Vorster 916 7361-5670 <br /> w (11 NAME OUANTRY LOST(GALLONS) <br /> aril;® gasoline U , <br /> (2) <br /> „- Diesel <br /> UNKNOWN <br /> i <br /> DATEDISCOVERED HDW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NULSANCEOONDITIONS <br /> w E:1M N O 0 Y Y <br /> TANK TEST TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> M M o o r Y ® UNKNOWN ❑ BEMOVEOONTENTS E] REPLACETANK ® CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED 7 ❑ REPAIR TANK ❑ REPAIRPPING ❑ CHANGEPROCEDURE <br /> O zn YES ❑ No PYES,DATE 0.11 M 2 ,j 2 I,j 8 .1 8 Y ❑ OTHER <br /> u� SOURCE OF DISCHARGE TANKS ONLYrAPACITY MATERIAL CAUSES) <br /> ❑ TANKLEAK ® UNKNOWN 1n,QQD )4 Gjn() GAL. ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE <br /> ❑ PIPINGLEAK AGE YRS ® STEEL ❑ CORROSION En UNKNOWN <br /> ❑ OTHER UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br /> wT CHECKONEONLY <br /> ❑ UNDETERMINED ❑ SOILONLY FX] GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F, CHECK ONE ONLY <br /> N <br /> ` X>@N SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS ❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> ti q ❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> ❑ CAP SITE(CD) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(Il) <br /> ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> F-1TREATMENT AT HOOKUP(HU) E::] NO ACTION REQUIRED INA) ❑ OTHER(OT) <br /> 15C451�1 <br />