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O STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINAON SITC'tiEPORT <br /> ELERDET�GY y wusrwTEOFj a,E EMER,E S�ERv( S EOR LOCALAGENCY USE ONLY IR I'• E TI- q�L f'D7HAT IHAVE <br /> REPORT BEEN FLED 7 O YES I� f HEREBY CERTIFY THAT I AM A DESGr F��U'..SEC.AN <br /> O YES, r—vy No _ ILJ REPOR7E0 THIS INFORMATION ro LacAl r 7 ION 25,e�::of <br /> L119 - 7H TH AND 9AFTY t (7 <br /> REPORT DATE .. ( <br /> IMI! M 1 9 0 8 Y -7 Y CASE! <br /> SKI /61LI (rr•`I �ll� <br /> J V DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNA <br /> Gerald W. Cates (209) 462-1100 /✓ "¢'� <br /> m REGIONAL BOARD COMPMIV OR AGENCY NAME - - <br /> a REPRESENTING -© OWNEWOPERATOR Q <br /> IL ¢ LOCALAGENCY [:] OTHER City of Stockton <br /> n <br /> ADDRESS <br /> 1465 S. Lincoln Street Stockton Ca 952( 6 <br /> STREET - DRY STATE , ZIP <br /> NAME CONTACTPERSON PHONE <br /> �¢ Cit of Stockton ❑ UNKNOWN Gerald Cates (209) 462-1100 <br /> g v ADDRESS <br /> a 1465 S. LincolnStockton Ca 9:)Zl,6 <br /> STREET DT' STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Smith .Cata` Pump Station Blake Guinn (209) 944-8731 <br /> a ADDRESS <br /> x Fontana Avenue and I-5 Stockton San Joaquin <br /> STREET DRY D NTN P <br /> wCROSS STREET TYPE OF AREA OCOMMERCIAL O INDUSTRIAL O RURAL TYPE OF BUSINESS O RETAIL FUEL STATION <br /> Country Club ME RESIDENTIAL OOTHER OFARM ZYOTHER. Government <br /> LOCALAGENCY AGENCY NAME CONTACTPERSON PHONE <br /> w San Joaquin County Health District Donna He rc-rl (209) 468-3432 <br /> �w REGIONAL BOARD PHONE <br /> w (1) - NAME QUANTITY LOST(GALLONS) <br /> #2 Diesel Fuel 1100 O UNKNOWN <br /> 20 (2) <br /> N <br /> UNKNOWN <br /> i 8 DATE DISCOVERED HOWDISCOVERED INVENTORY CONTROL E:] SUBSURFACE MONITORING NUISANCE CONDITIONS <br /> 1 O 2 7 J <br /> Y TANKTEST O TANK REMOVAL ❑ OTHER <br /> M M D 0 Y <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> w M M D D v Y = UNKNOWN ® REMOVEOONTENTS REPLACE TANK O CLOSETANK <br /> HAS DISCHARGE BEEN STOPPED? _ P. REPAIRTANK EJ REPAIRPPNG E:1 CHANGE PROCEDURE <br />} <br /> -O f YES Q NO IFYES,DATE M 1.1 0 .1 30 8 Y 7 , E:] OTHER <br /> w SOURCE OF DISCHARGE TANKS ONLWCAPACITY MATERIAL CAUSE(S) <br /> TANK LEAK O UNKNOWN 5,000 GAL FIBERGLASS O OVERFILL RUPTUREFAILURE <br /> El PIPING LEAK AGE 10 YRS STEEL CORROSION El <br /> UNKNOWN <br /> O OTHER Q UNKNOWN OTHER O SPILL O OTHER <br /> w w CHECK ONE ONLY <br /> V� O UNDETERMINED- -SOILONLY O GROUNDWATER DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECKONEONLY <br /> wx U rn SITE <br /> INVESTIGATION IN PROGRESS <br /> PPROBLEM) <br /> En CLEANUP IN PROGRESS ❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> TAKEN <br /> Q a CLEANUP MONITORING IN SSE] NO FUNDS AVAILABLE TO PROCEED O EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) - - - - <br /> 1 �2 F'� CAPSITE(CD) O EXCAVATE&DISPOSE(ED) E] REMOVE FREE PRODUCT(FP) O ENHANCED BK)DEGRADATION(IT) <br /> 00 <br /> O CONTAINMENT BARRIER(CB) O EXCAVATE&TREAT(ET) PUMP&TREAT GROUNDWATER(GT) O REPLACE SUPPLY IRS) <br /> O TREATMENTATHOOKUP(HU) O NO ACTION REOUIRED INA) OTHER(OT) <br /> q <br /> r <br /> z <br /> w <br /> Z <br /> . NSD OS(1.8)7 <br /> I{( <br />