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3500 - Local Oversight Program
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PR0544236
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
3/6/2019 6:50:45 PM
Creation date
3/6/2019 3:50:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0544236
PE
3526
FACILITY_ID
FA0024238
FACILITY_NAME
JM EQUIPMENT COMPANY
STREET_NUMBER
1245
Direction
W
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16323034
CURRENT_STATUS
02
SITE_LOCATION
1245 W CHARTER WAY
P_LOCATION
01
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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U <br /> UNDERGROUND STORAGE TAN UNAUTHORIZED RELEASE (LEAK)/ CONTAMINATION SITE REPORT <br /> EMERGENCY HASSTATEOFFICEOFEMERGENCYSERVICES FOR LOCAL AGENCY USE ONLY <br /> REPORT BEEN FI LED 7 ❑ YES NO 1 HEREBY CERTIFY THAT I.HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> ❑ YES NO DIS �S ��SRU TION H ET ON THE BACK PAGE OF11T.HIS F RIA <br /> CASE• ///yyVYYREPOYEDATE L �/V� DATE <br /> Y 1IV <br /> M NAM V PHONE SIGN RP <br /> NAMEOF INDIV UAL FILING REP rur'' 3,9 4) <br /> pREGIONAL BOARD COMPANY OR AGENCY NAME �pqq•�{ <br /> r REPRESENTING E] OWNERIOPERATOfl ❑ h <br /> S LOCALAGENCY ElOTHEfl /�,/ / <br /> A DRESS (� �I yf/) � /`1/—Li4�.. Aq <br /> < �1 <br /> C' � srR LWPHONE <br /> lYl•1[ J(f 7 STAIILLtZIP <br /> Ef �I�J CONTACT PERSON <br /> J, NA <br /> m / Ci ❑ UNKNOWN <br /> W n ADDREI$ , pV" 4 53 1 STATE <br /> „R PHONE IP <br /> )V! <br /> FACILITY NAME(IF APPLICABLE) OPERATOR <br /> z J, :V co <br /> UADDRESS / JAk <br /> O Ct ,��M V�/V°r ✓ � • COUNLY IP <br /> �= CROSS S7REE <br /> N <br /> CONTACTPERSON <br /> CI LOCALAGENCY AGENCY NAME Lk A ���' - { ) (/A•7Cf` y6 y,3�y( <br /> WV PHONE <br /> w w REGIONAL BOARD <br /> �_a QUANTITY LOST(GALLONS) <br /> NAME <br /> w (1) 1 UNKNOWN <br /> ZW s <br /> � <br /> m i R) ❑ UNKNOWN <br /> �- <br /> DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> i <br /> r/�'/� ;)- ❑ TANKTEST E] TANK REMOVAL Ll <br /> �Y IMI vM D Y Y <br /> METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> DATE DISCHARGE BEGAN <br /> arvf UNKNOWN ❑REMOVE CONTENTSOCLOSE TANK&REMOVE ❑REPAIR PIPING <br /> o mLON Y ❑REPAIR TANK E]CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> HAS DISCHARGE BEEN STOPPED? <br /> `^ ❑ YES ❑ NO IFYES,DATE M MI o Y Y REPLACE TANK OTHER <br /> O SOURCE OF DISCHARGE CAUSE(S) <br /> L y `I-yI/.JNKNOWN ❑ OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> ❑ TANK LEAK lXJ <br /> r" CORROSION NKNOWN ❑ OTHER <br /> 006 ❑ PIPING LEAK ❑ OTHER ❑ <br /> ww CHECKONEONLV <br /> wa <br /> ❑ UNDETERMINED ❑ SOIL <br /> GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> i y PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> E] NO ACTION TAKEN <br /> W ❑ POST CLEANUP MONITORING IN PROGRESS <br /> ¢r ❑ SITE ASSESSMENT UNDERWAY <br /> LEAK BEING CONFIRMED E] PRELIMINARY <br /> V w ❑ E] CASE CLOSE <br /> CHECK <br /> COMPLETED OR UNNECESSARY) E] CLEANUPUNDERWAY <br /> REMEDIATION PLAN <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE 8 DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ <br /> ENHANCED BIO DEGRADATION(IT) <br /> I 8"OKfOfl°E"M'"IPUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(AS) <br /> a z ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ <br /> o O ❑ ❑ VENT SOIL(VS) <br /> W <br /> CONTAINMENT BARRIER(CB) NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) <br /> a ❑ VACUUM EXTRACT(VE) ❑ OTHER(OT) <br /> Sri '� 5 l�f ti^f PY1 U, (v"ere It D i YL Vel <br /> 0+ f Ci <br /> s Gt�oct�e vv�ev� i HSG W("q <br />
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