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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT <br />EMERGENCY HASSTATEOFFICEOFEMERGENCVSERVICES FOR LOCAI,AGENCYUBEOKY <br />_J YES NO REPORT BEEN FILED z I <br />. YES ® NO HEREBY CERTID THAT i AM A OESIC{lATED GOVERNMENT EMPLOYEE AND THAT t HAVE <br />THISFY <br />REPORT DATE ���D THIS MFORMATION TO LOCAL OFFICIALS RURSUANT TO SEGTIOF1.25T801 OF <br />cgBEa �R.EEP <br />PMOODE. <br />]MI, iM 0 20 9y 3y� <br />NAME OF INDIVIDUAL FILING REPORT PHONE TURE <br />>I Ralph E. Grant (302 426-2899 <br />m <br />o <br />k' <br />REPRESENTING ® OWNEVOPERATOq ❑ REGIONAL BOARD <br />COMPANY OR AGENCY NAME <br />p <br />a <br />❑ LOCALAGENCV ❑ OTHER <br />.-- <br />Rollins Leasing Corp. #143 <br />lI ADDRESS <br />One Rollins Plaza, Wilmington, DR 19803 <br />STREET <br />I NAME CONTACT PERSON STATE =IF <br />Rollins Leasing Corp.E:] UNKNOWN Ralph E. Grant (304 426-2899 <br />u <br />ADDRESS <br />w <br />One Rollins PlazadE,Wilmington, DE 19803 <br />FACILITY NAME (IF APPLICABLE) trtY SATE P <br />OPERATOR <br />PHONE <br />Rollins Leasing Corp. #143 Rollins Leasing (20q 948-1500 <br />a <br />I ADDRESS <br />Loomis Road,TREStockton, CA, San Joaquin, 95205 <br />yCROSS <br />850 <br />STREET Cm ,T,y MP <br />TVPEOFAREA ® COMMERCIAL ❑ INDUSTRIAL [—]RURAL TYPE OF BUSINESS $ <br />Frontage Road ❑ RErlva eTl°" <br />❑ RESIDENTIAL ❑ OTHER <br />❑ FARM ® OTHER �� <br />1CALAGENCY AGENCY NAME 7 <br />CONTACT PERSON PHONE <br />t. <br />w <br />w <br />San Joaquin County Letitia Briggs (209 468-3468 <br />a a <br />REGIONAL BOARD <br />PHONE <br />C <br />Diesel Fuel NAME QUANTITY LOST (GALLONS) <br />UNKNOWN <br />(2 <br />w <br />TOATEDISCOVEREO <br />w <br />HOW DISCOVERED ❑ UNKNOWN <br />® INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCECONDIT%INS <br />k' <br />1M `AM 20 8 0 9,1 3 y ❑ TANK TEST ❑ TANKREMOVAL ® OTHER prQdUet line test <br />DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br />j} <br />M M � 0 Y V ❑ <br />❑ UNKNOWN ❑ REMOVECONTENTS ❑ REPLACETANK CLOSE TANK <br />4 <br />p <br />HAS DISCHARGE BEEN STOPPED? ❑ REPAIR TANK ® REPAIR PIPING ❑ CHANGE PROCEDURE <br />n YES ® NO IF VES, GATE <br />a 20 L 9 r 3y ® OTHER power to DumD Cut Off System <br />w <br />j <br />SOURCE OF DISCHARGE O <br />TANKB ONLYA;APACITY MATERIAL CAUSE(S) <br />❑ TANKLEAK ❑ UNKNOWN 12,000 GAL. ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE <br />® PIPING LEAKAGE 14 YRS EX STEEL ❑ CORROSION UNKNOWN <br />❑ OTHER ❑ UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br />ww <br />CHECK ONEONLV <br />a <br />o <br />E] UNDETERMINED ® SOILONLV ❑ GROUNDWATER ❑ DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br />F <br />CHECK ONE ONLY <br />2 N <br />¢a <br />❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ® CLEANUP IN PROGRESS❑ SIGNED OFF (CLEANUP COMPLETED OR UNNECESSARY) <br />v ua <br />❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br />CHECK APPROPRIATE ACTION(S) (SEE BACK FOR DETAILS) <br />❑ CAP SITE (CDI $ ❑E%CAVATEA DISPOSE (ED) ❑ REMOVE FREE PRODUCT FP) ❑ ENHANCED BIODEGRADATION (IT) <br />❑ CONTAINMENT BARRIER (CB) ❑ EXCAVATE &TREAT (ET) ❑ PUMP A TREAT GROUNDWATER (GT) ❑ REPLACE SUPPLY IRS) <br />L <br />❑ TREATMENT AT HOOKUP (HU) <br />Np/O ACTION REQUIRED INA) ❑ OTHER (OT) <br />�(❑ �j' <br />✓ V 1 �'/p����v,✓����-/� Q�l���Jppp" l�:t ,y-Y�- <br />J/ice <br />�'U't./(c �J[2'r•L,� / (� • e)Iq " <br />.ng <br />