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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 /> REPORT BEEN FILED? '1 HEREBY CERTIFY-THAT I HAVE DISTRIBUTED THIS]INFORMATION ACCORDING TOTHE <br /> []YES ®NO [:]YES ®NO DISTRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM <br /> REPORT DATE CASE# <br /> 0 7 1 6 0 3 <br /> M M D DL Y V _ , <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNA <br /> m John Schetter 800-525-5857 x6233 <br /> uj REPRESENTING ® OWNER/OPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME <br /> 0- BP West Coast Products L <br /> O ❑LOCALAGENCY ❑ OTHER <br /> ujADDRESS <br /> 4 Centerpointe Drive La Palma CA 90623 <br /> STREET CITY STATE <br /> Lu J NAME CONTACT PERSON PHONE ZIP <br /> m <br /> u)It BP West Coast Products LLC ❑ UNKNOWN John Schetter <br /> a a ADDRESS 800-525-5857 x6233 <br /> LCO4 Centerpointe Drive La Palma CA 90623 <br /> STREET CITY STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Z Arco Facility No. 02076 L J S Enterprise Inc. 209-334-3678 <br /> ADDRESS <br /> 0 800 E. Kettleman Lane Lodi San Joaquin 95240 <br /> w STREET <br /> N CROSS STREET CIN COUNTY ZIP <br /> Hwy 99/Kettleman Lane <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w Z Count of San Joaquin/Environmental Health Division DougWilson 209-468-3446 <br /> w w REGIONAL BOARD <br /> a< PHONE <br /> Central Valley Regional Water Quality Control Board 5 916-255-3000 <br /> Uo (�) NAME QUANTITY LOST(GALLONS) <br /> Lu <br /> Z 3 Gasoline <br /> F-j (2) ® UNKNOWN <br /> DATE DISCOVERED ❑ UNKNOWN <br /> Z HOW DISCOVERED ❑ INVENTORY CONTROL <br /> f 0 7 1 5 0 3 ❑ SUBSURFACE MONITORING ❑ NUISANCE-CONDITIONS <br /> W ❑TANK TEST ❑TANK REMOVAL ® OTHER Product Line Upgrade <br /> m DATE DISCHARGE BEGAN Y Y METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> }W M1 M1 01 DI A ®UNKNOWN ❑ REMOVE CONTENTS ❑ CLOSE TANK&REMOVE ❑ REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED? Y ❑ REPAIR TANK ❑ CLOSE TANK&FILL IN PLACE CHANGE PROCEDURE <br /> U <br /> U <br /> p ®YES ❑ NO IF YES,DATE M M DI DI Y Y ❑ REPLACE TANK ® OTHER Replaced Product Piping <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ❑ TANK LEAK Z UNKNOWN ❑ OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> 0 U ❑ PIPING LEAK ❑ OTHER ❑ CORROSION ® UNKNOWN <br /> ❑ OTHER <br /> wwCHECK ONLY ONE <br /> LuLu -1 UNDETERMINED ® SOIL ONLY ❑ GROUNDWATER [:] DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONLY ONE <br /> W ❑ NO ACTION TAKEN E] PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ® POLLUTION CHARACTERIZATION <br /> aai ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY <br /> ❑ POST CLEANUP MONITORING IN PROGRESS <br /> U ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> J (SEE BACK FOR DETAILS) <br /> Lu O ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GR) ❑ REPLACE SUPPLY(RS) <br /> W¢ ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ❑ VACUUM EXTRACT(VE) ® OTHER TBD <br /> The concentrations of the soil sample results are as follows: TPH-g 75 mg/kg, Benzene ND, MTBE ND, Xylenes 1 mg/kg and <br /> Z <br /> Lead 83 mg/kg. <br /> Z <br /> w <br /> Soil samples collected during the June 2003 line upgrade reported very low concentrations of TPHg and Xylenes which are <br /> 0 likely from the previous release which was fully characterized during investigations in the mid 1990's. <br />