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UNDERGROUND STORAGE TANK AUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT <br /> HAS STATE OFFICE OF EMERGENCY SERVICES FQR:LO..GAL-"AGFJ.Ki'Y:US£IDW*- *. .;;.....::>':::a`:;::. ..;:'i.:: .. :::::::::::ili::.::::::;:::' <br /> EMERGENCY REPORTBEEN FILED? EH£REBYGERTIFYTHAT.lim:Ap£Si NA D�at?V RNMENTEMPLOYEE AND THAI f <br /> YES =X NO Q 1�5 = NJ HAVEFtEPORTERTHISiNfpRMATtON:TDI OGAL QFFICIAGSAURSUANTTgSLCTIpPJ <br /> 2"xt€it]7L?F TH£.M�RLT.H.AND:SAFETY.CODE,.... <br /> .................................................................................................................................................. <br /> REPORT DATE(MM-DD-YY) CASE# <br /> :: <br /> 11/29/90 13 802 <br /> >:.SI�NED.::;::. .;• .. ::.:. .::.. .: '../DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNAT RE <br /> m Elaine Lavine (415)-571-2482 <br /> LU REPRESENTING =X OWNERIOPERATOR =REGIONAL BOARD COMPANY OR AGENCY NAME <br /> 0 =LOCAL AGENCY DOTHER ARCO Products Company <br /> CL <br /> ui ADDRESS P.O.Box 5811 San MateoCA 94402 <br /> STREET CITY STATE ZIP <br /> LU NAME CONTACTPERSON PHONE <br /> J <br /> Fn ARCO Products Company =UNKNOWN Elaine J.Lavine (415)-571-2482 <br /> no <br /> co a ADDRESS PO BOX 5811 ATTN: Env.Compl.Dept. San Mateo CA 94402 <br /> LLJ <br /> Cl STREET CITY STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> o ARCO FACILITY 06020 GARY L BURGIN (209)-823-4715 <br /> o ADDRESS 1711 E YOSEMITE MANTECA SAN JOAQUIN 95336 <br /> STREET CITY COUNTY ZIP <br /> w <br /> ~ CROSS STREET <br /> HWY 99/E YOSEMITE <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w w SAN JOAQUIN COUNTY PUBLIC HEALTH DOUG WILSON (209)-468-3400 <br /> w Ld REGIONAL BOARD PHONE <br /> am <br /> a CENTRAL VALLEY REGION LEE BOGGS (916)-361-5600 <br /> co (1) NAME QUANTITY LOST(GALLONS) <br /> ui <br /> a w GASOLINE <10GAI-S =UNKNOWN <br /> ED (2) QUANTITY LOST(GALLONS) <br /> D <br /> =UNKNOWN <br /> DATE DISCOVERED(MM-DD-YY) HOWDISCOVERED =INVENTORY CONTROL 0 SUBSURFACE MONITORING =NUISANCE CONDITIONS <br /> CC 11/28/1990 =TANK TEST =TANKREMOVAL =OTHER DRIVEOFF <br /> ui <br /> > DATE DISCHARGE BEGAN(MM-DD-YY) METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> Ow 11/28/1990 =UNKNOWN REMOVE CONTENTS REPLACE TANK CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED? REPAIR TANK REPAIR PIPING =CHANGE PROCEDURE <br /> Q YES ONO IF YES,DATE 11/28/1990 Q OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ui Uj <br /> ¢ =TANK LEAK UNKNOWN OVERFILL =RUPTURE/FAILURE =SPILL <br /> 37) <br /> coo =PIPING LEAK [E OTHER E] CORROSION [::3 UNKNOWN 0 OTHER DRIVE OFF <br /> w w CHECK ONE ONLY <br /> v ®UNDETERMINED =SOIL ONLY =GROUNDWATER [:]DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> - CHECK ONE ONLY <br /> Z Cn <br /> a NO ACTION TAKEN 0 PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED 0 POLLUTION CHARACTERIZATION <br /> a: <br /> Er a = LEAKBEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY =POSTCLEANUP MONITORING IN PROGRESS <br /> O 0 REMEDIATION PLAN 0 CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) =CLEANUP UNDERWAY <br /> J CHECK APPROPRIATE ACTION(S) [:]EVACUATE AND DISPOSE(ED) =REMOVE FREE PRODUCT(FP) =ENHANCED BIO DEGRADATION(IT) <br /> o p CAP SITE(CD) EVACUATE AND TREAT(El) 0 PUMP 8 TREAT GROUNDWATER(GT) =REPLACE SUPPLY(RS) <br /> =CONTAINMENT BARRIER(CB) 0 NOACTION REQUIRED(NA) =TREATMENT AT HOOKUP(HU) =VENT SUPPLY(VS) <br /> CC =VACUUM EXTRACT(VE) =OTHER(OT) <br /> Cn <br /> CUSTOMER DROVE OFF WITH NOZZLE IN CAR. DEALER TURNED EMERGENCY SWITCH OFF. CLEANED UP <br /> Z <br /> SPILL WITH SAND. SAN JOAQUIN COUNTY AND OES NOTIFIED. <br /> 0 <br /> 0 <br />