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UAR/PROP 65_PRE 2019
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PR0232372
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
5/24/2021 11:28:35 AM
Creation date
11/5/2018 1:34:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0232372
PE
2381
FACILITY_ID
FA0003631
FACILITY_NAME
ONE CANLIS
STREET_NUMBER
24
Direction
S
STREET_NAME
HUNTER
STREET_TYPE
ST
City
STOCKTON
Zip
95202
APN
14914024
CURRENT_STATUS
02
SITE_LOCATION
24 S HUNTER ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\H\HUNTER\24\PR0232372\UAR_PROP 65.PDF
Tags
EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/ CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> ❑ YES �NO REPORT BEEN FILED T ❑ YES ❑ NO I HEREBY CERTIFYTHAT I HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> DISTRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM <br /> REPORTDATE CASE♦ /� t^�//�/L/ 1 <br /> y Q SGNED DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE <br /> ( V& tY <br /> G REPRES NG REGIONAL BOARD COMPANY OR AGENCY NAME <br /> ¢ ❑ OWNERaOPERATOfl ❑ <br /> S LOCAL AGENCY ❑ OTHER �� n �j �c 4,le /t l-4< vLCy <br /> ADDR(ESS`S[ w A T{(J /`� ^ <br /> / Z 5- `• Q,fREE,•�(/ - LI... ,�} S„Y - Gaff.- I C,)- <br /> -/' v psz� <br /> J NAME CONTACTPERSON PHONE <br /> Q a �v L ❑ UNKNOWN rL sot <br /> a u ADDRESS c s <br /> cm STATE :- <br /> FACILITY NAME(IF APPLICABLE) OPERATOR HONE <br /> o J co" <br /> p< ADDRESS <br /> OG R T CIS / <br /> Ry SPREE! CRY COUNTY ZIP <br /> —y CROSS STREET <br /> /M 4 v k &7'— <br /> O LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> z_y <br /> w <br /> w w REGIONAL BOARD PHONE <br /> ya (1) NAME QUANTITY LOST(GALLONS) <br /> 0 <br /> Z ©fes: UNKNOWN <br /> > (2) <br /> rn z = ❑ UNKNOWN u <br /> Z DATE DISCOVERED\ HOW DISCOVERED ❑ INVENTORY CONTROL ❑ URFACE MONITORING ❑ NUISANCE CONDITIONS J� <br /> u y OD y Y ❑ TANKTEST ❑ TANK REMOVAL OTHER <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(C CK ALL THAT APPLY) <br /> wy o v r UNKNOWN ❑REMOVE CONTENTS E::]CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED? ❑REPAIR TANK ❑CLOSE TANK E FILL IN PLACE ❑CHANGE PROCEDURE <br /> o E!<YES ❑ NO IF YES,DATE y D Y Y ❑REPLACE TANK ❑ OTHER <br /> SOURCE OF DISCHARGECAUSES) <br /> ❑ TANK lE UNKNOWN ❑ OVERFILL ❑ RUPTUREIFAILURE ❑ SPILL <br /> ❑ PIP LEAK ❑ OTHER ❑ CORROSION ❑ UNKNOWN ❑ OTHER <br /> w w CHECK EONLY <br /> O UNDETERMINED ❑ SOILONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> zZ ❑ NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> jw ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS <br /> O ❑ <br /> REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> IS£9CX RAmTAf81 <br /> o ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNOWATER(GT) REPLACE SUPPLY IRS) <br /> w a ❑ CONTAINMENT HARRIER(CB) ❑ NO ACTON REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ❑ VACUUM EXTRACT(VE) ❑ OTHER(07) <br /> Ac 61 �Kvf�/, s.1c ass�sss..� .uccss <br /> v I/ Necml&+u <br />
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