Laserfiche WebLink
UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE LEAK /CONTAMINATION SITE REPORT <br /> EMERGENCYEj <br /> , .... -:: -. <br /> YES F-1 NO ❑X YES NO ESYA�ET1�Y"f{£k77?jhYTi]5TfYJ�[1't'1 'j[$$�'lbR, 'f}{a(<F <br /> auS@Rt+H? fb#H�t��Yf9tt{tkkSHdWHb6t'ttE BACN^Yna6?Yh7nS <br /> 11 21 21 41 01 6� 06-7588 <br /> M M D D Y Y $1G 4}A¢$ <br /> NAME OF INDIVIDUAL FILLING REPORT <br /> ir" <br /> Corey McMillan (336)315-2837 ` <br /> N A NA <br /> REPORTED O LOCALAGENCY ri REGIONAL BOARD <br /> BY OI OWNEWOPERATOR OTHER Gllbarco Veeder Root <br /> ADDRESS <br /> 7300 W.Friendly Ave Greensboro NC 27420-2087 <br /> STREET CITY ST ZIP <br /> Safeway,Inc. James Schwartz F925-469-7306 <br /> RESPONSIBLE <br /> PARTY A <br /> P.O.Box 9070 Pleasanton CA 94588-3229 <br /> STREET CITY ST ZIP <br /> FACILITY NAME PHONE <br /> Safeway-Nor Cal 2707 Lisa Page 209-472-8600 <br /> SITE <br /> LOCATION 6425 N Pacific Stockton CA 95207 <br /> ADDRESS CITY ST ZIP <br /> GROSS STREET <br /> LOCAL AGENCY AGENCY NAM <br /> AGENCIES County of San Joaquin COPA Doug Wilson 209-468-3446 <br /> PHONE <br /> OES Ruben Rodriguez 800-852-7550 <br /> NAI T— <br /> A ALL N <br /> Gasoline <br /> SUBSTANCE 3 gallons ❑X <br /> INVOLVED Z QUANTITY LOST(GAL1751797 <br /> E]UNKNOWN <br /> uvh�uHOW <br /> 1 2 2 4 0 6 TANK TEST TANK REMOVAL NUISANCE CONDITIONS <br /> M M D D Y Y ❑INVENTORY CONTROL ❑SUBSURFACE MONITORING Seen Visually %❑ <br /> METHOD USED TO STOP DISCHARGE <br /> DATE DISCHARGE BEGAN O UNKNOWN REMOVE CONTENTS CLOSE TANK&FILL IN PLACE O <br /> DISCOVERY 1 2 21 4 0 6 REPAIR TANK REPAIR PIPING E] <br /> HAS DISCHARGE BEEN STOPPED X YES NO 8 REPLACE TANK CHANGE PROCEDURE O <br /> ABATEMENT 11 21 21 41 01 6 CLOSURE TANK&REMOVAL Dispensing disabled OTHER® <br /> U TA )TANK TEST UNKNOWN OOVERFILL UNKNOWN 0PIPING LEAK OTHERCORROSION SPILL ❑Dispenser ❑REPTURE/FAILURE Auto nozzle shut off failed OTHER Ex <br /> CHECK ONE ON7— <br /> CASE TYPEOTHER Concrete SOIL ONLY GROUNDWATER DRINKING WATER(WELLS AFFECTED) Ej <br /> CHECK ONE ONLY <br /> CURRENT ONO ACTION TAKEN PRELIMINARY SITE ASSESSMENT SUBMITTED POLLUTION CHARACTERIZATION O <br /> STATUS O LEAK BEING CONFIRMED ®PRELI MINARY SITE ASSESSMENT UNDERWAY POST CLEANUP MONITORING IN PROGRESS Q <br /> O REMEDIATION PLAN ©CASE CLOSED(COMPLETED/UNNECESSARY) CLEANUP UNDERWAY <br /> CAP SITE(CD) EXCAVATE&DISPOSE(EDI REMOVE FREE PRODUCTIFP) <br /> REMEDIAL CONTAINMENT BARRIER(CB) EXCAVATE&TREAT(En PUMP&TREAT GROUNDWATER(GT) O <br /> ACTION VACUUM EXTRACT(VE) NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) 0 <br /> 9 VENT SOIL(VS) OTHER ENHANCED BIO DEGRADATION(M) ❑ <br /> Auto nozzle shut off failed on pump#13 causing gaoline to reach concrete pavement <br /> Station used absorbent material to clean the spill and Was assisted by the fire department <br /> COMMENTS Safeway has responded to this issue and all necessary action has been taken. <br /> No further actions are currently planned. <br /> 127 55 AM <br /> nr:I <br />