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UNDERGROUND STORAGE I. _..K UNAUTHORIZED RELEASE LEAK /CU, _-kMINATION SITE REPORT <br /> EMERGENCY DES REPORT FILED FCIRLQCAL/iG£NCY:EISEOTfLY <br /> El YES NO YES NO F1Rt6YC£ 711 f3tA (;tqfb57#t�dl�lIi:Y{41$IiIEORk1Al�ddi <br /> REPORT DATE CASE# AG£.OR3NNG7D TYEE pFSTRt8U7K7ty S}401hN{]i`THE:SACK_PAGE DFTHf5 FORid <br /> o� 21 11 11 01 4� 04-0751 <br /> M M D D Y Y .i .::;:`. <br /> NAME OF INDIVIDUAL FILLING REPORT PHON <br /> Ian A. Ellis (860)651-2851 G`— <br /> REPRESENTING COMPANY OR AGENCY NAME <br /> REPORTED =LOCAL AGENCY REGIONAL BOARD <br /> BY EX OMERIOPERATOR E]OTHER Gilbarco Veeder Root <br /> ADDRESS <br /> 7300 W.Friendly Ave Greensboro NC 27420-2087 <br /> STREET CITY ST ZIP <br /> NAME CONTACT PERSON <br /> Safeway-Nor Cal Heather Moon 925-469-7306 <br /> RESPONSIBLE <br /> PARTY ADDRESS <br /> P.O BOX 9070 Building 6000 Pleasanton CA 94588 <br /> STREET CITY ST ZIP <br /> FACILITY NAME OPERATOR PHONE <br /> Safeway-Nor Cal Katrina Johnson 209-830-2950 <br /> 2600 <br /> SITE <br /> LOCATION 1804 W 11th St Tracy CA 95376 <br /> ADDRESS CITY ST ZIP <br /> CROSS STREET <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> AGENCIES County of San Joaquin CUPA Doug Wilson 209-468-3446 <br /> PHONE <br /> IDES Bob Mcrae 800-852-7550 <br /> 1 NAME QUANTITY LOST(GALLONS) <br /> Gasoline <br /> SUBSTANCE 10 gallons <br /> INVOLVED 2 QUANTITY LOST(GALLONS) <br /> UNKNOWN <br /> DISCOVERED <br /> O 2 1 1 0 4 TANK TEST TANK REMOVAL NUISANCE CONDITIONS <br /> M M D D Y Y El INVENTORY CONTROL SUBSURFACE MONITORING Seen Visually OTHER E] <br /> METHOD USED TO STOP DISCHARGE <br /> DATE DISCHARGE BEGAN UNKNOWN REMOVE CONTENTS CLOSE TANK&FILL IN PLACE <br /> DISCOVERY 01 21 11 11 01 4 REPAIR TANK REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED X YES NO <br /> & �REPLACE TANK CHANGE PROCEDURE <br /> ABATEMENT 01 21 11 11 01 4 CLOSURE TANK&REMOVAL customers Vehicle removed. OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> O TANK TEST UNKNOWN OVERFILL UNKNOWN Q <br /> PIPING LEAK OTHER �X CORROSION SPILL <br /> Vehicle Tank REPTURE/FAILURE See Comments OTHER EX <br /> CHECK ONE ONLY <br /> CASE TYPE MX OTHER Concrete SOIL ONLY GROUND WATER 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 E] <br /> REMEDIATION PLAN ®CASE CLOSED(COMPLETED/UNNECESSARY) CLEANUP UNDERWAY <br /> CHECKAPPROPRIATE ACTION(S) <br /> CAP SITE(CD) FIEXCAVATE&DISPOSE(ED) REMOVE FREE PRODUCT(FP) <br /> REMEDIAL CONTAINMENT BARRIER(CB) EXCAVATE&TREAT(ET) PUMP&TREAT GROUNDWATER(GT) <br /> ACTION VACUUM EXTRACT(VE) NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) E] <br /> VENT SOIL(VS) OTHER See Comments ENHANCED BIO DEGRADATION(IT) <br /> A customer error on site caused gasoline to reach concrete surface. <br /> All Product was contained to concrete surface. <br /> COMMENTS Safeway has responded to this issue and all necessary action has been taken.No further actions are currently planned. <br /> 2/202004 <br /> 12:45 PM <br />