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SITE HISTORY
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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GRANT LINE
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3776
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3500 - Local Oversight Program
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PR0545211
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SITE HISTORY
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Entry Properties
Last modified
1/24/2020 4:51:46 PM
Creation date
1/24/2020 4:44:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE HISTORY
RECORD_ID
PR0545211
PE
3528
FACILITY_ID
FA0005216
FACILITY_NAME
ALEXANDER GILLILAND
STREET_NUMBER
3776
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
23907002
CURRENT_STATUS
02
SITE_LOCATION
3776 W GRANT LINE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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ILS-- <br /> 4� <br /> TIi <br /> UNDERGROUND STORAGE TANK UNAUO <br /> RIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT <br /> EMERGENCY NAS STATE OFFICE OF EMERGENCY SERVICES F.OR LOCALAGENCY 1l5E 0�1EY <br /> REPORT BEEN Fq ED? I:HEREBY CERTIFY TAOAT]Ai�4 R D>:SIGNR_TED GOVERNFAEI47 EMPLflY1 E ANa THAT't RAVE <br /> [�YES ❑ pEppRTED fHls 11tFOR)ulATldV TO EOC c7FFIC[ALS PURSUANT TO 5EGT[ON 2519d?OF <br /> YES [ THEN TN ANO SAFTY CODE <br /> 1„-- <br /> REPORTOATE CASE# QATE., <br /> .:SiGN <br /> 0.1 mID oI r 0 Y PHONE SIGNATURE <br /> �I NAME OF INDIVIDUAL FILING REPORT <br /> REPRESENTING ❑ OWNERlOPSRATOR ❑ RE NAL BOARD <br /> PANYORAGENCYNAME � /✓ (�L!<J L� �y <br /> S Lu <br /> LOCALAGENCY ❑ OTHER <br /> EL <br /> J O <br /> 1 �. A ESS <br /> ''}y SI'A ZIP <br /> Q , v srRE <br /> CONTACT PERSON PHONE <br /> y ME <br /> � � ��/I�/Q V" {kLV�` ❑fUNKNOWN �e C.-i►! ��T,N / �/� � <br /> y a ADDRESS <br /> Q STRM <br /> FACILITY NAME(IF APPLICABLE) OPERATOR + PHONE <br /> Z <br /> 4 <br /> U� ADDRESS <br /> Q CROSS STREET rRr=S[pENTLAL <br /> EA ❑COMMERCIAL❑ INDUSTRIAL❑RURAL TYPE OF BUSINESS ❑ RETAIL FUEL STATION <br /> u FAAm OTHER <br /> PHON <br /> ❑OTHER ❑ ❑ <br /> LOCALAGENCY 5f<jrfli� CONTACT PERSON <br /> i21, w w REGIONAL BOARD PHONE <br /> CL <br /> (1) <br /> NAME f QUANTITY LOST(GALLONS) <br /> tu <br /> U w ► I C L�.SIL Wl 11 ! gf1-06It iVJ Q ❑ UNKNOWN <br /> 4 � <br /> ~q [Z) <br /> ❑ UNKNOWN <br /> I. DATE DISCOVERED ►IOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING - ❑ NUISANCE CONDITIONS <br /> = <br /> I` vu (/' TANK LEST TANK REMOVAL ❑ OTHER <br /> 0M /M o r r ❑ <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> ❑ UNKNOWN ❑ REMOVE CONTENTS ❑ REPLACE TANKI❑ CLOSE TANK <br /> M M o o y v HAS DISCHARGE BEEN STOPPED 7 ❑ O T K ❑ REPAIRPIPWIG I CHANGE PROCEDURE <br /> ❑ xE5 ND IFYES,DATEMl Ml n1 . 11 <br /> Y uf <br /> ui SOURCE OF DISCHARGE TANKS ONLWCAPACITY MATERIAL - CAUSE(S) <br /> cn <br /> i ❑ TANKLEAK UNKNOWN 3oa40c7J0 GAL. ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTUREIFAILURE <br /> 1 r7PIPINGLEAK AG�0E- ZQa4 YRS STEEL ❑ CORROSION C] UNKNOWN <br /> ❑ OTHER UNKNOWN ❑ OTHER ❑ SPIN ❑ OTHER <br /> ww CHECKONEONLY <br /> UCL <br /> ❑ UNDETERMINED ❑ SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECK ONE ONLY <br /> z O <br /> `u ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> v ti ❑ NO AOTION TAKEN ❑ POST CLEANUP MONRORING IN PROGRESS [:jNO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTIONS)(SEE BACK FOR DETAILS} <br /> z <br /> F] CAP SITE(CD) F-71EXCAVATE6 DISPOSE(ED) ❑ REMOVE FREE PRODUCT") <br /> i5 o ❑ ENHANCED BIO OEGRAflAT10N(IT} <br /> w� [—] CONTAINMENTBARRIER(CB) ❑ EXCAVATE TREAT(ET) ❑ PUMPbTREAT GROUNDWATER(GI) ❑ REPLACE SUPPLY(RS) j <br /> w ❑ TREATMENT AT HOOKUP(HU) ❑ NO AOTION REOUIRED(NA) ❑ OTHER(OT) �J <br /> �tr� 6✓ IC rem; f / ye vle ac/ Go a�ni.�u tra�y ropy <br /> C/IhG/t�r��o'k sti Sfa r ks JK a '/ ki I �Z �G� <br /> ��, s 7 �tss(fA 47-7 e- be, <br /> r <br /> ... - HSCoS1�71 <br />
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