Laserfiche WebLink
EMERGENCY <br /> ID <br /> OE- AGENC' <br /> EPO ES FILED NO <br /> ❑ ❑ EClR LOGAl, YUSE'bNLY"' ...... <br /> YES X NO ..... _.,-. _,... ...._..... -. <br /> REPORT DATE (:HERE$Y"rI-RT.W.YTHATfHAVEDIsT.MsLrCEOTfRIttFD <br /> Ryfyfq?ION <br /> CASE 6 <br /> 01 41 21 5 A"ORpiNG T4 THE DNSTRS$tfTION SHOWN OF THE BACK.PAGE OFTHte FORM.. <br /> 1 3 13-2487 <br /> M M D D Y Y <br /> NAME OF INDIVIDUAL FILLING REPORT E . <br /> HO E SIG -- <br /> Eric Bruesch (336)315-2699 <br /> -St <br /> ED' <br /> REPRESENTING 7 <br /> COMPANY OR AGENCY NAME <br /> REPORTED <br /> REPRESENTING <br /> REGIONAL BOARD <br /> BY OWNERlOPERATOR OTHER Gilbarco Veeder Root <br /> ADDRESS <br /> 7300 W.Friendly Ave Greensboro NC 27420-2087 <br /> 57REET CITY ST ZIP <br /> NAME CONTACT PERSON <br /> RESPONSIBLE Safeway-North California Stan Olea 925-467-2707 <br /> PARTY ADDRESS <br /> 5918 Stoneridge mall rd Bldg 6000,2nd floor <br /> Pleasanton CA 94588 <br /> STREET CITY ST ZIP <br /> FACILITY NAME OPERATOR <br /> PHONE <br /> Safeway-Nor Cal MANAGER 209-461-5555 <br /> 517E <br /> LOCATION 6425 N Pacific Stockton CA 95207 <br /> ADDRESS CITY ST ZIP <br /> CROSS STREET <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE - <br /> AGENCIES SAN JOAQUIN County Diane Martinez 209-468-3420 <br /> PHONE <br /> IDES Courtland Ellis 800-852-7550 <br /> Gasoline NAME QUANTITY LOST(GALLONS) <br /> SUBSTANCE 2 gallons Ex <br /> INVOLVED F 2 QUANTITY LOST(GALLONS) <br /> UNKNOWN <br /> DATE DISCOVERED HOW DISCOVERED <br /> 0 4 21 5 1 3 FITANK TEST TANK REMOVAL NUISANCE CONDITIONS <br /> M M D D Y Y ❑1NVEN7ORY CONTROL SUBSURFACE MONITORING Seen Visually OTHER Ej <br /> METHOD USED TO STOP DISCHARGE <br /> DATE DISCHARGE BEGAN UNKNOWN REMOVE CONTENTS CLOSE TANK&FILL IN PLACE <br /> DISCOVERY 0 41 21 51 11 3 ❑REPAIR TANK REPAIR PIPING ❑ <br /> HAS DISCHARGE SEEN STOPPED X YES NO <br /> & �REPLACE TANK CHANGE PROCEDURE <br /> ABATEMENT O 4 21 51 11 31 ❑CLOSURE TANK&REMOVAL See comments OTHER <br /> SOURCE OF.DISCHARGE CAUSE(S) <br /> TANK TEST UNKNOWN 0 OVERFILL UNKNOWN <br /> PIPING LEAK OTHER F-X� FICORROSION SPILL <br /> customer error REPTURE I FAILURE Auto shutoff failure OTHER <br /> CHECK ONE ONLY <br /> CASE TYPE EX OTHER Concrete SOIL ONLY GROUNDWATER DRINKING WATER(WELLS AFFECTED) <br /> CHECK ONE ONLY <br /> CURRENT NO ACTION TAKEN PRELIMINARY SITE ASSESSMENT SUBMITTED POLLUTION CHARACTERIZATION <br /> STATUS LEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY POST CLEANUP MONITORING IN PROGRESS <br /> 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 CONTAINMENT SARRIER(CB) EXCAVATE&TREAT(ET) PUMP&TREAT GROUNDWATER(GT) <br /> ACTION VACUUM ExTRACT(VE) NO ACTION REQUIRED(NA) TREATMENT AT HCOKILI <br /> VENT SOIL(VS) �X OTHER See Comments ENHANCED BIO DEGRADATION(M <br /> Auto nozzle shutoff failed on dispenser 13. <br /> As a result 2 gallons of fuel impacted the concrete.No fuel impacted the storm drain or soil. <br /> COMMENTS Fuel was cleaned up with spill kit(FM 186 hydro carbon cleaner agent)and absorbent pads. <br /> Safeway has responded to this issue and all necessary action has been taken.No further actions are currently planned. <br /> 10:26 AM <br />