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UAR/PROP 65_PRE 2019
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2300 - Underground Storage Tank Program
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PR0231341
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
9/15/2021 1:23:23 PM
Creation date
11/5/2018 3:48:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0231341
PE
2361
FACILITY_ID
FA0003629
FACILITY_NAME
ARCO STATION #434*
STREET_NUMBER
501
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
03119028
CURRENT_STATUS
02
SITE_LOCATION
501 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\K\KETTLEMAN\501\PR0231341\UAR_PROP 65.PDF
Tags
EHD - Public
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I , - w <br /> UNDEFuROUND STORAGE TA - UNAUTHORIZED RELEASE (LEAK)/ WAMINATI N E <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES (. LDCAL'AGENCY USE ONLY <br /> REPORT BEEN FLED 7 <br /> ❑ YES No ❑ YES ❑ No flHENVCffMTmTf.HAVE D6TREARMING WCRMAT)ON ACCORDP)GTOTHE <br /> D6SIOWNOII.THE INSTRUCTION,JO d <br /> N S ON THE BACK PAGE OF THIS FORM <br /> REPORT DATECASEuSE. :RIHTT)DN ,.. <br /> QJ 1 d , �. BINIED <br /> NAME OF WDNDUAL FLING REPLATE <br /> R10NE 3 RE <br /> o Lc c� hty)6�o-S� �63 <br /> w <br /> REPRESENTING OWNEROPERUTOR ❑ REGIONAL BOARD COMPANY OR AGENCY E <br /> El AGENCY F7 OTHER O <br /> R <br /> ADDRESS <br /> ( C L Iia c ;F Ro61]-z <br /> w NAME <br /> 4(se�lf"., <br /> ]J CONTACT � P(HjONEa �v l ❑ UNKNOWN au ` K2,5-) <br /> J7� �� <br /> FACLTTY NAME(IF APPL LE) OPERATOR sem•-...- <br /> N CCS <br /> < ADDRESS C sa <br /> �� ► w . l.-VCM <br /> w CROSS STRE7TT <br /> p LOCAL NCY AGENCY NAME <br /> r w CONTACT PERSON PHONE <br /> Y 3Y <br /> W� REGONAL � lam ) 6 � <br /> < PHONE <br /> m (LI NAME <br /> QUANTITY LOST R3ALLDN3) <br /> L I iJ c- <br /> LmloaowN <br /> m <br /> i wTE DISCOVERED HOW DISCOVERED <br /> oUNKNOWN <br /> w <br /> INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ I NUNUISANCE CONDITIONS <br /> 0J uI O o I r ❑ TANK TEST \. TAW REMOVAL OTHER O ( C( yh <br /> wTE DLSCLARGE BEGAN i <br /> METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> UNKNOWN ❑REMOVE CONTENTS ❑CLOSE TANKL REMOVE ❑REPAIR PIPING <br /> 8 KRGE BEEN STOPPEp 7 ❑REPAIR TANK ❑CLOSE TANK i FILL W CHANGE PROCEDURE <br /> PLACE <br /> -O ®/ YES ❑ NO IF YES DATE �1 ��J I I!, �� v CC v ❑REPLACE TA �OTHER �✓n <br /> M( <br /> SOURCE OF DISCHARGE Y� CLUSEfS) �C <br /> ¢` ❑ TANK IF/11C �( UNIOOWN <br /> A�1 ❑ OVERFILL ❑ RUPTUREIFALURE ❑ SPLL <br /> U ® <br /> PIPING LEAKOAR <br /> ❑ ❑ CORROSION ® UNKNOWN ❑ OTHER <br /> `i CHECK ONE ONLY '�(+ <br /> u Y� UNDETERMINED CD <br /> SOL ONLY ❑ GROUNDWATER ❑ DRINKING WATER .(CHECK ONLY IFWATER WELLS NAVE ACTUALLY BEEN AFFECTED( <br /> CHECK ONE ONLY <br /> z <br /> aZ ❑ NO ACTON TAKEN ❑ PRELWNARYS(TEASSESSMENTNORKM-ANSUBMOTED ❑ POLLUTIONCHARACTERIZATON <br /> UH ❑ LEAKBENGCONFIRMED PRELIMNARY SITE ASSESSMENT UNDERWAY <br /> ❑ POST ClEM1UP MONITORING IN PROGRESS <br /> ❑ <br /> REMEDIATION PLAN ❑ GSE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTON(S) <br /> Ie.Cu 1v1T.Vi ❑ EXGVATEL EDI <br /> DLSPOSE( ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BO DEGRADATIO07) <br /> a ❑ CAP SITE(COI <br /> w g ❑ EXCAVATE i TREAT(ET) ❑ PUMP i TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> i ❑ CONTAINMENT BARRIER(CS) NO ACTON RECUIRED Q((i��A) 7fEAlLEHT AT HOOKUP <br /> IHUI ❑ VENT SOL(VS) <br /> ❑ VACUUUU.MEXTRACT(VE) �OTHER(OT) �;.W � EATME <br /> C(/i!/AZriT -�7` cl /I�'.eQw C�$e fzL, /Ta�ct/c c 1 <br /> 7-t <br /> 40p <br /> Ki OKNq <br />
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