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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EL DORADO
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1901
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3500 - Local Oversight Program
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PR0544688
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
7/24/2019 9:39:44 AM
Creation date
7/24/2019 9:31:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0544688
PE
3526
FACILITY_ID
FA0001946
FACILITY_NAME
El Dorado Food Mart
STREET_NUMBER
1901
Direction
S
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
16508019
CURRENT_STATUS
02
SITE_LOCATION
1901 S EL DORADO ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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q <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES ' FOR. LOCAL'AGENCY USE ONLY 3 <br /> REPORT BEEN FILED ? ,% ` NO 1 HEREBY CERTIFYTHATI HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> ❑ YES NO ES ❑ <br /> . DISTRIBUTION SHOWN ON THE SHEET ON THE BACK PAGE OF THIS FORM. - <br /> REPORT DATE CASES <br /> mi 2 mi <br /> q• r SIGNED DATE <br /> NAME OF INDIVIDUAL FI TNG REPORT PHONE S flE <br /> ✓ Iiso � o t oo c q ) Ga�Ig <br /> w REPRESENTINGREGIONAL BOARD <br /> ❑ OWNER/OPERATOR COMPANY OR AGENCY NAME❑ <br /> p >L CAL AGENCY ❑ OTHER stm J <br /> ADDRESSLi <br /> Wei vu.�-� , y3r� F►czo�' S-I ,IG-► uv) CA �Y52D Z <br /> �• ST � <br /> REET crtY STATE ZIP <br /> NAME <br /> COKTACCjT 1P,�EIRSSON }� PHONE <br /> ` <br /> w ¢ QU. I GIS I� VCi ❑ UNKNOWN ITU. YV✓1 rv <br /> a < ADDRESS <br /> 3125 J sTR <br /> v�Q. 4 �Mod (%+-o Gk c� Z50 <br /> FACILITY NAME (IF APPLICABLE) OPERATOR s PHONE <br /> - N - V E � � oAg4fB 684 ) <br /> w ADDRESS � O OJDI 5�fLU - Ca�,� 4! Ljoa ut a5,A <br /> y/ YYln <br /> CITY COUNTY <br /> CROSS STREET �_f <br /> LOCAL AGENCY AGENCYNAME CONTACTPERSON PHONE <br /> _ _ <br /> ; � Evlu► rovlvnenlzi ! IJ�G1Y no ( ) $- <br /> w REGIONAL BOARD PHONE <br /> ¢ o MB ( QUANTITY LOST (GALLONS) <br /> UNKNOWN(lasol ) vi . ToL � �h 0n <br /> hO2 <br /> ( ) 0) cs (f� I ZUNKNOWN <br /> r DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ N IUIISSANCE CONDITIONS <br /> p <br /> w I Oo �o " I Y � r ❑ TANKTEST ❑ TANKREMOVAL OTHER 4Gr2S1A..0,N <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) <br /> ED <br /> - <br /> UNKNOWN ❑ REMOVE CONTENTSCLOSE TANK6 REMOVE ❑ REPAIR PIPING <br /> W M M O O Y Y <br /> 0 HAS DISCHARGE BEEN STOPPED 7 E] REPAIR TANK E] CLOSE TANK & FILL IN PLACE ❑ CHANGE PROCEDURE (� <br /> y <br /> o VES ❑ NO IF VES, GATE I M v M� �o o � r Y REPLACE TANK ❑ OTHER <br /> � w <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> f° ❑ TANK LEAK UNKNOWN ❑ OVERFILL ,❑ RUPTURE/FAILURE ❑ SPILL 1 <br /> m0 ❑ PIPINGLEAK F-1 OTHER E:: CORROSION XI / UNKNOWN ❑ OTHERI I .T' <br /> w CHECKONEONLY �fl <br /> Q UNDETERMINED ❑ SOILONLY ❑ GROUNDWATER ❑ DRINKING WATER - (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> ¢ a <br /> NO ACTION TAKEN E:] PRELIM INARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> > LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS <br /> QN ❑ REMEDIATION PLAN ❑ CASE CLOSED (CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE & DISPOSE (ED) ❑ REMOVE FREE PRODUCT (FP) ❑ ENHANCED BIODEGRADATION (IT) <br /> ISFEBKI[R] M&tsI <br /> < Z <br /> Q Q ❑ CAP SITE [CD) ❑ EXCAVATE & TREAT (ET) ❑ PUMP & TREAT GROUNDWATER (GT) ❑ REPLACE SUPPLY IRS) <br /> W . <br /> w ¢ ❑ CONTAINMENT BARRIER (CS) ❑ NO ACTION REQUIRED INA)) /' ❑ TREATMENT A, T^HgOKUP (HU) ❑ VENT SOIL (VS) <br /> F-] VACUUMEXTRACT (VE) �THER (OT) ( 06Sc <br /> Wi e r(T red u v ec! 10 c tcvMwL <br /> zm 4m gaywu Cwld Co✓I,-fa i•>�Iu�tc(,tjpv� . <br /> O <br /> Q <br /> Ns� � IA�oI <br />
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