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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES ALALENCY USE ONLYvES ® NO REPOR78EENFILED? YES ® NO NF ERTIFY T AT ATIM ATO SLOCAL OFFICALS PURSUANT TO IGNATED GOVERNMENT EE CTION 518S7AND THAT I AOF <br /> REPORTDATE CASE#` Y DDM 2 M 1 9 D 8 v OY DATE C� <br /> NAME OF INDIVIDUAL FILING REPORT PHONE I SIGN TURP <br /> Diane M. Hinson (?09 )468-3441 <br /> REPRESENTING O OWNER/OPERATOR Q REGIONALSOARD COMPANY OR AGENCY NAME <br /> xC�tLOCALAGENCY ❑ OTHER San Joaquin Local Health District <br /> M ADDRESS <br /> 1601 &TREE(E. Hazelton Avenue DTTYStockton STATE CA 95205 <br /> L4 NAME CONTACTPERSON <br /> PHONE <br /> y¢ Shell Oil Company UNKNOWN John Walker (916 )372-3116 <br /> <y ADDRESS <br /> m <br /> w (� <br /> 15th SMEETSouth River Road c"West Sacramento STATGA 95691 <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Shell Oil - Bulk Storage Plant Shell Oil Company ( ) <br /> ADDRESS <br /> 3515 STREET Nav Drive D.Stockton SQ,�Joaquin U203 <br /> -y CROSS STREET ITYPE OF AREA O COMMERCIAL®INDUSTRIAL RURAL TYPEOF13USINESS <br /> O 0 RETAIL FUEL STATION <br /> Q RESIDENTIAL Q OTHER Q FARM E�3 OTHER bu 1 k S to rage <br /> g LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> San Joaquin Local Health District D,w REGIONAL BOARD M ins (209 )468-3441 <br /> n PHONE <br /> RW CB - Central Valley Region #5 Bob Niblack (916 )361-5681 <br /> W 111 NAME OUANTITY LOST(GALLONS) <br /> 0 <br /> Gasoline )E0 UNKNOWN <br /> o (2) <br /> h <br /> UNKNOWN <br /> W DATE DISCOVERED HOWD19COVEREO O INVENTORY CONTROL SUBSURFACE MONITORING NUISANCECONDITIONS <br /> M M D D 8v1 ❑ <br /> Y TANK TEST EX� TANK REMOVAL OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> M M p D v Y ® UNKNOWN REMOVECONTENTS REPLACE TANK ® CLOSETANK <br /> Q HAS DISCHARGE BEEN STOPPED? REPAIRTANK E] REPAIR PIPING CHANGEPROCEDURE <br /> p YES 5a NO IFYES,DATEOTHER <br /> M M p D Y Y <br /> SOURCE OF DISCHARGE TAN"UNILYA:APACITY MATERIAL CAUSE(S) <br /> ❑ TANKLEAK ® UNKNOWN 2,000 GAL. 0 FIBERGLASS O OVERFILL RUPTUREFAILURE <br /> PIPING LEAK 2-50D O&L)MS STEEL CORROSION UNKNOWN <br /> O OTHER g] UNKNOWN age OTHER O SPILL O OTHER <br /> ww CHECKONEONLY <br /> o� O UNDETERMINED O SOILONLY ® GROUNDWATER O DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECK ONE ONLY <br /> m <br /> Q SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) CLEANUP IN PROGRESS O SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> UN 0 NOACTIONTAKEN ❑ POST CLEANUP MONITORING IN PROGRESS O NO FUNDS AVAILABLE TOPROCEED D EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> o CAP SITE(CD) 0 EXCAVATE&DISPOSE(ED) REMOVE FREE PRODUCT(FP) ENHANCED BIO DEGRADATION(IT) <br /> ❑ CONTAINMENT BARRIER(CB) 0 EXCAVATE&TREAT(ET) PUMP&TREATGROUNDWATER(GI) REPLACE SUPPLY(RS) <br /> E] TREATMENTAT HOOKUP(HU) NO ACTION REQUIRED(NA) El OTHER(OT) <br /> y RWQCB presently overseeing clean up investigation for hazardous waste discharge <br /> 6 generated from aboveground storage tanks. <br /> KscosR� <br />