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UNDERGROUND STORAGE TANK <br /> EMERGENCY UNAUTHORIZED RELEASE LEAK /CONTAMINATION SITE REPORT <br /> OES REPORT FILED OR ❑ LF X�— <br /> YES �% NO X YES NO �'�LkRfON <br /> REPORT DATE CASE❑ ❑ � � � X <br /> 01 61 31 01 01 61 06-3885Gi17�e k9X�§UTQnLglapkl1;� DeT nsPw M <br /> NAME OF INDIVIDUAL FILLING REPORT QNp.F •" `)a��..�,\�`� �'� 'BATE <br /> Corey McMillan 336-315-2837 <br /> REPRESENTING COMPANY OR AGENCY NAME <br /> REPORTED O LOCALAGENCY O REGIONAL BOARD <br /> BY �OWNER/OPERATOR ID OTHER Gilbarco Veeder Root <br /> ADDRESS <br /> 7300 W.Friendly Ave Greensboro NC 27420-2087 <br /> STREET CIN ST <br /> NAME CONTACT PERSON ZIP <br /> Safeway,Inc. [James SchwartzRESPONSIBLE925-469-7306 <br /> PARTY --- <br /> P <br /> P.O. Box 9070 Pleasanton CA 94588-3229 <br /> STREET <br /> FACILITY NAME CITY <br /> OPERATOR ST ZIP <br /> PHONE <br /> 1769 Safeway-Nor Cal Sharon Louveture 209-461-5555 <br /> SITE <br /> LOCATION 2808 Country Club Blvd Stockton CA 95204 <br /> ADDRESS <br /> CROSSSTREET CITY sT ZIP <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> AGENCIES County of San Joaquin CUPA Doug Wilson 209-468-3446 <br /> PHONE <br /> OES Bob McRae <br /> 800-852-7550 <br /> 1 NAME <br /> Gasoline QUANTIT-LOST(GALLONS) <br /> SUBSTANCE 5 gallons Qx <br /> INVOLVED 2 QUANTITY LOST(GALLONS) <br /> =UNKNOWN <br /> 01 611 21 41 0 6 F-1TANKTEST �TANKREMOVAL NUISANCE CONDITIONS <br /> M M D D Y Y E]INVENTORY CONTROL SUBSURFACE MONITORING Seen Visually OTHER X❑ <br /> METHOD USED TO STOP DISCHARGE <br /> DATE DISCHARGE BEGAN UNKNOWN REMOVE CONTENTS CLOSE TANK&FILL IN PLACE <br /> DISCOVERY Q 6 2 40 6 REPAIR TANK REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED x VES NO <br /> & =REPLACE TANK CHANGE PROCEDURE _ <br /> ABATEMENT 01 61 21 41 01 6 CLOSURE TANK&REMOVAL Delivery drop stopped OTHER <br /> SOURCE OF DISCHARGE CAUSES) <br /> O TANK TEST UNKNOWN = =OVERFILL UNKNOWN = <br /> O PIPING LEAK OTHER =X E CORROSION - SPILL <br /> Tank Delivery ❑REPTURE/FAILURE Delivery Driver Error OTHER ❑X <br /> CHECK ONE ONLY <br /> CASE TYPE El OTHER Concrete ❑SOILONLY GROUNDWATER DRINKING WATER(WELLS AFFECTED) <br /> CHECKONEONLY <br /> CURRENT NO ACTION TAKEN PRELIMINARY SITE ASSESSMENT SUBMITTED POLLUTION CHARACTERIZATION 0 <br /> STATUS O LEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY POST CLEANUP MONITORING IN PROGRESS = <br /> O REMEDIATION PLAN ®CASE CLOSED(COMPLETED/UNNECESSARY) CLEANUP UNDERWAY = <br /> CHECKAPPROPRIATE ACTION(S) <br /> =CAP SITE(CD) EXCAVATE&DISPOSE(ED) REMOVE FREE PRODUCT(FP) <br /> REMEDIAL O CONTAINMENT BARRIER(OB) =EXCAVATE&TREAT(ET) PUMP&TREAT GROUNDWATER(GT) <br /> ACTION O VACUUM EXTRACT(VE) O NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) _ <br /> ElVENT SOILIVS) OTHER ENHANCED BIO DEGRADATION(IT) <br /> Delivery driver error for the regular tank caused gasoline to reach concrete pavement. <br /> Station used absorbent material to clean the spill. <br /> COMMENTS Safeway has responded to this issue and all necessary action has been taken. <br /> No further actions are currently planned. <br /> 7/102006 <br /> 11:16 AM <br />