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SITE INFORMATION AND CORRESPONDENCE
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545338
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
2/12/2020 10:01:28 AM
Creation date
2/12/2020 8:21:48 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545338
PE
3528
FACILITY_ID
FA0003803
FACILITY_NAME
KETTLEMAN CHEVRON
STREET_NUMBER
601
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04728006
CURRENT_STATUS
02
SITE_LOCATION
601 E KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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r <br /> r&A) 9�-- � ® <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELE SE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES OR LO AGENCY!]S1=ONLYro <br /> REPORT BEEN FILED?0 1HERE C HAT 1 HAVE.DISTRIBUTEDTHISINFORMATIONACCORDINGTOTHE YES NO 0 YES NO <br /> 7� plSTli T SH STAUCT)ONSHEET.ONTHE BACK.P.AGEOF_: HIS:FDANL <br /> REPORT DATECASE s A <br /> i.' <br /> ! Y SIGHED <br /> Lol <br /> DATE :: .... <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNA <br /> lar kl� tit' i��i (?Dl) 43 <br /> w REPRESENTING 0 OWNERIOPERATOR Q REGIONAL BOARD COMPANY R AGENCY NAME <br /> crLOCAL AGENCY F] OTHER S � <br /> ¢ AD RE - }} <br /> t�D. SPU✓4t� S1 TDh! (A <br /> STREET CITY STATE ZIP <br /> NAME CONTACT PERSON PHONE <br /> coJ <br /> i¢ -7,UNKNOWN Pa ske AVS) ��C760 <br /> Oa a ADDRESS <br /> w <br /> Lu qWD GSW ar.ew 4CO CITY <br /> STREET CITY STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> v <br /> ADDRESS�I L ' �k�; 04 Ai ' `�" Ls_ <br /> 0 <br /> Lu CITY COUNTY ZIP <br /> �= CROSS STREET <br /> rn <br /> O LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> z � S <br /> w1, b ( ) <br /> �W <br /> V <br /> :L'U-t it REGIONAL BOARD PHONE <br /> (1) NAME QUANTITY LOST(GALLONS)LU <br /> Q <br /> Jo ��ry f']���' ' ,, ` <br /> l�jp'-e-bowi UNKNOWN O <br /> m z (2) <br /> a— <br /> w <br /> UNKNOWN <br /> F- DATE DISCOVER <br /> E�D �/1 HOW DISCOVERED O INVENTORY CONTROL SUBSURFACE MONITORING El NUISANCE CONDITIONS <br /> O M1 SMI /I`-o -1. q Y r TANK TEST E] TANK REMOVAL OTHER <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> Q <br /> n Y Y <br /> UNKNOWN REMOVE CONTENTS E::]CLOSE TANK 8 REMOVE �REPAIR PIPING <br /> M o <br /> p HAS DISCHARGE BEEN STOPPED? ii REPAIRTANK CLOSE TANK&FILL IN PLACE D CHANGE PROCEDURE <br /> o YES NO IF YES,DATE u MI o o Y Y REPLACE TANK E::]OTHER <br /> SOURCE OFDISCHARGE CAUSE(S) <br /> cc a TANK LEAK UNKNOWN 0 OVERFILL E] RUPTUREIFAILURE SPILL <br /> 00 a PIPING LEAK OTHER 0 CORROSION � UNKNOWN OTHER <br /> L n CHECK ONE ONLY <br /> o UNDETERMINED Q SOIL ONLY KA GROUNDWATER F_� OR INKII IG WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> w NO ACTION TAKEN PRELIMINARY SITE ASSESSMENT WORKPLANSUBMITTED E::] POLLUTION CHARACTERIZATION <br /> cc LEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY POST CLEANUP MONITORING IN PROGRESS <br /> O REMEDIATION PLAN 0 CASE CLOSED(CLEANUP COMPLETED OR UNN ECESSARY) CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) EXCAVATE S DISPOSE(ED) REMOVE FREE PRODUCT(FP) ENHANCED BIO DEGRADATION(IT) <br /> (SEE BACK FM BETAnSI <br /> n p CAP SITE(CD) EXCAVATE&TREAT(ET) Q PUMP&TREAT GROUNDWATER(GT) REPLACE SUPPLY IRS) <br /> LU <br /> M a CONTAINMENT BARRIER{C$J NO ACTION REQUIRED(NA) 0 TREATMENT AT HOOKUP(HU) 0 VENT SOIL(VS) <br /> ¢ ❑ <br /> VACUUM EXTRACT(VE) � OTHER( <br /> (OT) � <br /> U C�ovr� i uwY1 Ira✓ 1�ru24�� �a.y ' �2i�bl+u v,2c� �3 4o�crn�s . <br /> Hsc c*Iaw <br /> - f - <br />
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