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UAR/PROP 65
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UAR/PROP 65
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Entry Properties
Last modified
7/6/2020 4:43:56 PM
Creation date
11/7/2018 4:41:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
RECORD_ID
PR0502373
PE
2381
FACILITY_ID
FA0005421
FACILITY_NAME
LIFE MEDICAL INDUSTRIES
STREET_NUMBER
2060
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
2060 E MAIN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\2060\PR0502373\UAR_ PROP 65.PDF
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EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES RLOCALAGENCY USE ONLY <br /> REPORT BEEN FILED? 1 H ESY CERTIFY HAT I M A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE: <br /> YES No Q YES ND RE ED THIS I ON.TO.LOCAL.OFFICIALS PURSUANj�Tq T SECTION 25180.7 OF <br /> REPORT DATE CASEi THE T �r <br /> /'�J Cl <br /> NiM I Y SIGNED' DATE <br /> NAME F INDIV DUAL FILING REPORT PHONE I SIG TURE <br /> O REPRESENTING O OWNEILOPERATOR O REGIONAL BOARD COMPANY OR AGENCY NAME <br /> p ;<OCALAGENCY O OTHER <br /> ADDRESS <br /> /r1 <br /> STREET 6 0 STATE <br /> ME CONTACTPERSON PHONE <br /> IR ❑ UNKNOWN )943 <br /> n ADDRESS <br /> LailsTREET cm srAr <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> L, M 3 <br /> ADDRESS2010 �} 1J <br /> O EIET CRY — <br /> H1;R SS STREET' TYPED �AREA tMMERCIAL E::]INDUSTRIAL O RURAL TYPEOFSUSINESS O RETAIL FUEL STATKNJ <br /> L O <br /> RESIDENTIAL =OTHER O FARM_OTHER <br /> g LOCAL AGEN AGE CV NAMEVONTACIPER N r(PH/HOON11E <br /> wS� <br /> w w WGK)NAL BOARD PHONE <br /> (1) NAME QUANTITY LOST(GALLONS) <br /> �� S UNKNOWN <br /> (2) <br /> m O UNKNOWN <br /> i DATE DISCOVERED HOW DISCOVERED O INVENTORY CONTROL O SUBSURFACE MONITORING O NUISANCEOONDIT/ONS <br /> M D v O TANK TEST _�j<TANK REMOVAL O OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> }� M M o o Yl <br /> Y UNKNOWN O REMOVECONTENTS O REPLACETANK �CLOSE TANK <br /> p �ASCHMGOEN STOPPED? <br /> op D TMEREPAIR TANK O REPAIR PIPING CHANGE PROCEDURE <br /> X ES <br /> NO <br /> (al <br /> u� SOURCE OF DISCHARGE TANKS ONLY�)CyAP�ACITY MATERIAL CAUSE(S) <br /> O TANK LEAK UNKNOWN 3Zv GAL. O FIBERGLASS O OVERFILL RUPTUREFALURE <br /> c� O PIPINGLEAK AGE YRS 5irSTEEL O CORROSION UNKNOWN <br /> O OTHER UNKNOWN O OTHER O SPILL O OTHER <br /> w� CHECK ONE ONLY <br /> UNDETERMINED O SOILONLY O GROUNDWATER 0 DRINKING WATER (CHECK ONLY IF WATER WELLS HAVE ACTUAL LY BEEN AFFECTED) <br /> F, CHECKONEONLV <br /> 2� <br /> wx <br /> ` SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) O CLEANUP IN PROGRESSO SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> V% O NOACTIONTAKEN O POST CLEANUP MONITORING IN PROGRESS O NO FUNDS AVAILABLE TO PROCEED O EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> $zz O CAP SITE(CD) O EXCAVATE&DISPOSE(ED) O REMOVE FREE PRODUCT(FP) O ENHANCED BK)DEGRADATION(IT) <br /> Y O CONTAINMENT BARRIER(CB) O E%CAVATE&TREAT(En O PUMP&TREAT GROUNDWATER(GT) O REPLACE SUPPLY IRS) <br /> O TREATMENTATHOOKUP(HU) O NO ACTION REWIRED INA) O OTHER(OT) <br /> �i.L� S [Tc aSsnb�'r UDtL(-- bE, 96CDUAM-3 -M bfT64VJJJ 6 -�(tl✓ <br /> NIRu-P-c' At*oD /-TF-wr OF c^oTAYvINYrric , As T-E@-lR� 64' "1tC6 <br /> KSC MiIA4/I <br />
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