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i <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)I CONTAMINATION SITE REPORT <br /> Ij <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR I.00AI;AGENCY USE OIILY <br /> REPORT BEEN FILED? .I HEREBY CE}M.MHAT.HAVE DISTRIBU ED THIS INFORMATION ACCOfaDIyG TOTHE <br /> ❑ YES NO YES [1] NO <br /> :DISTRIBUTION SHOWN;ON THE IHSTRUCTION:SHEF ON;THE BACK PAGE OF,THIS FOR. <br /> REPORT DATE CASES <br /> 4 9 2 Y 23137 s�cNE�.... <br /> DarE. <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE _ <br /> } Bernetta wess (415) 571-2434 <br /> m <br /> + REPRESENTING 25OWNEFVOPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME - - <br /> 1 p ❑ LOCAL AGENCY L] OTHER <br /> ARCO Products CO. <br /> ADDRESS <br /> P.O. Box. 5811 Sap,,Mateo, CA 94402 CITY STATE ZIP <br /> J NAME CONTACT PERSON PHONE <br /> F, <br /> � ARCO Products Co. ❑ UNKNOWN Kyle Christie (415 )571-2434 <br /> CC <br /> 0 a ADDRESS - - <br /> Wa P.O. Box 5811 (Attn: Ryle Christie) San Mateo, CA 94402 <br /> t STREET CITY STATE ZIP <br /> t FACILITY NAME ff APPLICABLE) - OPERATOR PHONE <br /> z SS# 548 MohammadliA. Taeb ( 209) 478-2723 <br /> ¢ ADDRESS <br /> 0 1612 Hammer Lane Stockton (San Joaquin) ; <br /> W STREET CITY COUNTY ZIP <br /> ~ CROSS STREET <br /> @ Brentwood <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON x PHONE <br /> # zCounty of San Joaquin Donna Heran ( 209) 468-3420 <br /> W U <br /> wLU <br /> REGIONAL BOARD PHONE <br /> Central Valley Region (Fresno) John Noonan (209) .445-5116 <br /> ! y (y) NAME QUANTITY LOST(GALLONS) <br /> LU <br /> `1) O w Petroleum Hydrocarbons ` UNKNOWN <br /> 1 Q J <br /> In z (2) 9 <br /> G? ❑ UNKNOWN <br /> Z DATEDISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> uMi 0M! 4 f 21 81 9 v 2 v ❑ TANK TEST >;� TANK REMOVAL OTHER <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> > ❑ UNKNOWN ❑REMOVE CONTENTSCLO5E TANK&REMOVE ❑REPAIR PIPING <br /> w M M O O Y Y <br /> HAS DISCHARGE BEEN STOPPED 7 tj 0 REPAIR TANK 0 CLOSE TANK&FILL IN PLACE E]CHANGE PROCEDURE <br /> S2 YES E] NO IF YES,DATE O M 4m, <br /> ZD 8 P Y 2 v ❑REPLACE TANK I?L ❑FOTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> w <br /> ¢ ❑ TANK LEAK UNKNOWN ❑ OVERFILL ❑ RUPTUREIFAILURE ❑ 'SPILL <br /> in U F-] PIPING LEAK [--jOTHER ❑ CORROSION UNKNOWN ❑ OTHER <br /> w m CHECK ONE ONLY <br /> - <br /> ❑ UNDETERMINED SOIL.ONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY :. <br /> w Z [7] NO ACTION TAKEN F--] PRELIMINARY SITE ASSESSMtNT WORKPLAN SUBMITTED.. POLLUTION CHARACTERIZATION <br /> ❑er <br /> LEAK BEING CONFIRMED ❑, PRELIMINARY SITE ASSESSMENT UNDERWAY # ❑, POST CLEANUP MONITORING IN PROGRESS <br /> U ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) 0 CLEANUP UNDERWAY <br /> t CHECK APPROPRIATE ACTIONS) `y� EXCAVATE b DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> IsEE eACK FOR DETA4S) 1, <br /> a ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> OO <br /> Ia ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU). ❑ VENT SOIL(VS) <br /> Cc <br /> LU ❑ VACUUM EXTRACT(VE) ❑ OTHER(OT) <br /> Soil sample obtained immediately beneath oil/hater seperator, <br /> LU TPH by 418.1=400 ppm. Oil/water sepertor.' removed from facility. <br /> O <br /> U ' <br /> OF f <br /> %Ole - MSC 0.5 1&901 <br /> r <br />