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-ool y <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES tLtlFttt�Cl�t.AC9E[dDYG9t>rtl.Y i' � <br /> REPORTBEEN FILED? .Y=DLT#'It l'tvtt'(AMADE hA C COVFR;huE`ITEfAPLAYE=AND 1l1ATl <br /> YES MX NO 0 IES ro HAv .HEpflfi#EXStM$$(t�JFCOMAT�CM r =cn!sPURSUANr-o SECTION <br /> 2'9A83T i'�Y4JW8-SI�ETY C <br /> REPORT DATE(MM-0D-YY) CASE# <br /> 05/07/91 16832 SIGNED, D <br /> ATE <br /> NAME OF INOMDUAL FLUNG REPORT PHONE SIGNATURE <br /> 'm Elaine Lavine (415)-571-2482 z <br /> REPRESENTING =T—XI_ONTPRLOPERATOR OREGIONALBOARD COMPANY OR AGENCY NAME <br /> ¢O �OCPLAGENCY I_NITHER ARCO Products Company <br /> ADDRESS P.O.Box 5811 San Mateo <br /> CA 94402 <br /> STREET CITY STATE ZIP <br /> NAME CONTACT PERSON PHONE <br /> Mvs <br /> ARCO Products Company =UNKNOWN Elaine J.Lavine (415)-571-2482 <br /> ADDRESS PO BOX 5811 ATTN: Env.Compl.Dept. San Mateo CA 94402 <br /> STREET CITY STATE ZIP <br /> FACILITY NAME OF APPUCABLE) OPERATOR PHONE <br /> F ARCO FACILITY 00434 EDWARD D SEQUEIRA 209)-333-0141 <br /> o ADDRESS 501 W.KEITLEMAN LANE LODI SAN JOAQUIN 95240 <br /> STREET CITY COUNTY ZIP <br /> CROSS STREET <br /> N <br /> HUTCHINS/W KETTLEMAN <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w— SAN JOAQUIN COUNTY PUBLIC HEALTH DOUG WILSON (209)-468-3420 <br /> w Z REGIONAL BOARD <br /> PHONE <br /> CENTRAL VALLEY REGION LEE BOGGS (916)-361-5600 <br /> w h) NAME CUANTITY LOST(GALLONS) <br /> J GASOLINEa UNKNOWN <br /> m j m _ OLLMTTITY LOST(GALLONS) <br /> m <br /> �+ =UNKNOWN <br /> DATE DISCOVERED(MM-DD-Y1) HOWDISCOVERED =NNENTORY CONTROL =SUESURFACE MONITORING =NUISANCE CCNOITIONS <br /> ¢Z 0503/1991 =TANK TEST =TANKREMOVAL =% OTHER DRIVE OFF <br /> > DATE DISCHARGE BEGAN(MM-DD-YY) METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> O <br /> 0, 05/03/1991 =.NKNOWN REMOVE CONTENTS REPLACE TANK =CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED 7 = REPAIR TANK = REPAIR PIPING =CHANGE PROCEDURE <br /> AYES =NO IFYES.DATE 05/03/1991 = OTHER REPAIR PUMP <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> >> =TANCLEAK = UNKNOWN = OVERRLL =RPIURE/FAILURE =SPILL <br /> �U =PPNG LEAK =X OTHER = CORROSION =UNKNOWN [XI OTHER DRIVE OFF <br /> w w CHECK ONE ONLY <br /> U =UNDETERMINED =SOL ONLY =GROUNDWATER =DFEJQ�IG WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> i- CTC(ONE ONLY <br /> =NO ACTION TAKEN = PfEJANARY SITE ASSESSMENT WORKPLAN SUBMITTED =POLLUTION CHARACTERIZATION <br /> U w =LEAK BEING CONFIRMED = PRELIMINARY SITE ASSESSMENT UNDERWAY =POSTCLEANUP MONITORING IN PROGRESS <br /> = REMEDIATION PLAN EK CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) =CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) =EVACUATE AND DISPOSE(ED) =FEMOYE FREE PRODUCT <br /> (FP) =ENHANCED BIO DEGRADATION QT) <br /> wO =CAP SITE(CD) =EVACUATE AND TREAT(ET) =PUrP&TREAT GROUNDWATER(GT) =REPLACE SUPPLY(RS) <br /> F� <br /> CONTAINMENT BARRIER(CB) =X NOACTION REQUIRED(NA) =TREATMENTAT HOOKUP(HU) =VENTSUPPLV(VS) <br /> =VACUUM EXTRACT(VE) =OTHER(OT) <br /> CUSTOMER DROVE OFF WITH NOZZLE IN CAR. DEALER CLEANED SPILL PUMP REPAIRED. SAN JOAQUIN <br /> COUNTY AND OES NOTIFIED. <br /> 0 <br /> O <br /> U <br /> IAI� r" <br />