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UAR/PROP 65_PRE 2019
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PR0500285
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
5/12/2021 4:58:44 PM
Creation date
11/5/2018 1:11:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0500285
PE
2333
FACILITY_ID
FA0004712
FACILITY_NAME
WILLIAM BURKHARDT
STREET_NUMBER
5154
STREET_NAME
HOGAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06112001
CURRENT_STATUS
02
SITE_LOCATION
5154 HOGAN LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\H\HOGAN\5154\PR0500285\UAR_PROP 65.PDF
Tags
EHD - Public
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...,.,.e <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)I CONTAMINATION SITE REPORT <br /> EMERGENCYHAS STATE OFFICE 7CE OF EMERGENCY SERVICF7 FOR LOCAL AGENCY USE ONLY CC,'�-�C- .+v E <br /> E::] YES REPORTBEEN FLED 7 E::]YES NO I HEREBY CERTIFY THAT i AM A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> REPORTED THIS INFORMATION TO LOCAL OFFICIALS PURSUANT TO SECTION <br /> /25180.7OF <br /> REPORTDATE CASES THEH 1ANUSA¢TYCODEr ¢� �7 <br /> 10.1 /M '?,15 Y SIGNED SATE <br /> NAME OF INDIVIDUAL FLING REPORT PHONE SIGNAT RE <br /> gizi,IA-) K-4JOu., Cb51 Yck-ryzo � 4:_ <br /> a REPRESE ING ❑ OWNEWOPERATOR ❑ REGIONALBOARD COMPANY OR AGENCY NAME j� <br /> 0 7AL AGENCY ❑ OTHER 'o 'n 14 ' S. GF �C'�QJY <br /> a <br /> a A RESS <br /> MEET `7 pfV WATE S ZIP <br /> NAMECONTACTPERSON PHONE <br /> - <br /> '4, / ❑ UNKNOWN /^� <br /> i ADORE/s/ [�,/� � LSA./ l�m � '7-rLvD <br /> FACILITY Nrp <br /> AAAME(IF APPLICABLE) OPERATOfl PHONE <br /> ADDRESS <br /> .r✓4� &TREEf IfY` MIYZIP <br /> IS CROSS STREET TYPE OF AREA ❑COMMERCIAL❑WDUSTRIA RURAL TYPE OF BUSINESS ❑/RETAIL FUfp1STATKMI <br /> ltv ❑RESIDENTIAL [::]OTHER ❑ FARM I- OTHER <br /> LOCAL AGE y V � � AGENCY NAME CONTACT I PHONE <br /> REGIONAL BOARD PHONE <br /> (1) NAME QUANTITY LOST(GALLONS) <br /> `-� 25"UNLNOWN <br /> �> (2) <br /> Z �A UM(NOWN <br /> DATE DISCOVERED / HOWDISCOVERED ❑ INVENTORYOONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> �J <br /> 0.16u •/o? .1 aylb v O TANK TEST F!3"TANC REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> y¢j u u D o Y Y C UNKNOWN ❑ REMOVECONTENTS ❑ REPLACETANK CLOSE TANK <br /> Q HAS DISC ES E] N IF YES,DATE �M `�rA Oo �D �Y Y E]TOPPED? ` OTHER <br /> TANK ❑ REPAIR PIPI G ❑ CHANCE PROCEDURE <br /> y SOURCE OF DISCHARGE TANKS ONLYCAPACITY MATERIAL CAUSE(S) <br /> ❑ TANK LEAK UNKNOWN 3 GAL. ❑ FIBERGLASS ❑ OVERFILL R REIFALURE <br /> ❑ PIPINGLEAK AGE Z YRS STEEL ❑ CORROSION UNINOWN <br /> ❑ OTHER ❑ UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER _ <br /> w CHECK ONE ONLY <br /> V: ❑ UNDETERMINED el�so'IL ONLY ❑ GROUNDWATER ❑ DRIN(INGWATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECK ONE ONLY <br /> w¢ <br /> Si INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS [-] SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> V NOACTIONTAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> 8 ❑ CAP SITE(CD) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> ❑ CONTAINMENT BARRIER IDS) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GIT) ❑ REPLACESUPPLY(RS) <br /> ❑ TREATMENTAT HOOKUP(HUI ❑ NOACTIONREOUIRED(NA) ❑ OTHER(OT) <br /> 2 u S 7- -t*., <br />
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