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SITE INFORMATION AND CORRESPONDENCE_CASE 2
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SITE INFORMATION AND CORRESPONDENCE_CASE 2
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Entry Properties
Last modified
3/9/2020 4:38:53 PM
Creation date
3/9/2020 2:28:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
CASE 2
RECORD_ID
PR0545440
PE
3528
FACILITY_ID
FA0003845
FACILITY_NAME
MUSD-DISTRICT OFFICE
STREET_NUMBER
2901
Direction
E
STREET_NAME
LOUISE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
19811004
CURRENT_STATUS
02
SITE_LOCATION
2901 E LOUISE AVE
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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?� -U30 <br /> 4 ...i <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCALAGENCY USE ONLY <br /> A YES REPORT BEEN FLED? Q YES ���NO I HEREBY CERTIFY:THAT I AM A DES KiVATEO GOVERNMENT EMPLOYEE:AND THAT I HAVE: <br /> ::..REPORTED::THIS INFORMATION TO LOCAL IC[ALS., TO SECTK)N 251801:0F <br /> REPORT GATE CASE• THE HEALTH CODE <br /> � <br /> CMI S (C/v _3v SIGNED <br /> NAME OF INDIVIDUAL FLING REPORT PHONED Y 033 SIGNATURE � <br /> t�(,rJM <br /> m <br /> w REPRESENTING ❑ OWNERIOPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME <br /> C(S ` <br /> p L L AGEN �{ f-CY ❑ OTHER q E'iG L f` ��• ` b � H-t/] <br /> a <br /> ADDRESS or <br /> EFS ./j�` �-'be_��� YCT' k STATE � AP <br /> NAME [ �//�� CONTACTPERSON n PHONE <br /> in 2 b S ' KJ- ❑ UNKNOWN ,c( �Crl K-+�/I37 <br /> J Z�LJ� <br /> ADDRESS S3�7 <br /> STATE rp <br /> FACILITY NAME(IF APPLICABLE) y� 1 lRO)8zs-32 OPERATORPHONE <br /> Mah�� V1 i i-"cd �ca� 1Tki rf G't�► z/ <br /> ADDRESS �( <br /> !u STREET ` t Cm c.A Ccl S� � p b 6 W <br /> W <br /> W <br /> CROSS STREET TYPE OF AREA F7 COMMERCIAL <br /> 'O [-]INDUSTRIAL F7 RURAL TYPE OF BUSINESS <br /> ❑ RETAIL FUEL STATION <br /> Tt ❑RESIDENTIAL L HER���Op (' ❑ FARM O ER <br /> LOCAL AGE CY AGENCY NAME CONT CT PERSON PHONE <br /> w REGIONAL BOARD PHONE <br /> CL <br /> C V cQ Ct <br /> (�) c NAME OUANTRYLOST(GALLONS) <br /> �" Q S Q�`✓1 L �/ UNKNOWN <br /> r(2) <br /> SZ' f UNKNOWN <br /> z DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> cm �c ( D S. (v v [:] TANK TEST TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> �NPNOWN L2-49-MOVE CONTENTS ❑ REPLACE TANK CLOSE TANK <br /> W M M D D Y Y <br /> HAS DISCHARGE BEEN STOPPED? ❑ REPAIR TANK a REPAIR PIPING ❑ CHANGE PROCEDURE <br /> p YES� J c , <br /> NO IF YES,DATE M M 1 o J o , 3v ❑ OTHER <br /> u� SOURCE OF DISCHARGE TANKS ONLY.CAPACITY MATERIAL CAUSE(S) <br /> F7TANK LEAK JNKNOWN ��GAL. Q FIBERGLASS ❑ <br /> OVERFILL ❑ RUPTURE/FAILURE <br /> 2 ❑ PIPING LEAK AGE �� YRS STEEL ❑ CORROSION L IIJ J NOWN <br /> ❑ OTHER ❑ UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br /> W a CHECKONEONLY <br /> U UNDETERMINED ❑ SOIL ONLY a GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECK ONE ONLY <br /> 2 ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> cr <br /> v y ❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED EVALUATING CLEANLY ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> b zz ❑ CAP SITE(CO) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> 2 ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE&TREAT(ET) ❑ PUMP 8 TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> ❑ TREATMENT AT HOOKUP(HU) ❑ NO ACTION REQUIRED(NA) ❑ OTHER(OT) <br /> W74A <br />
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