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UNDERGROUND STORAGE TANK UNAUT4i' 1LL j kELIEASEAK)1 CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES 1 j r .'.FdRV6CALAGtNCY USE ONLY <br /> REPORT BEEN FILED? �[ TR�i�I�Y THA Li' <br /> A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> YES [ NO YES_[�i W N } H G�N�F�Fi AT10N TO LOCAL OFFICIALS PURSUANT TO SECTION 25180.7 OF <br /> REPORT DATE CASE K 1r' ' <br /> M M D v v SIGNED:-:-:-:: ---- /. DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNAT E <br /> Elaine Lavine (415) 571-2482 <br /> QREPRESENTING OWNER/OPERATOR F-1REGIONAL BOARD COMPANY OR AGENCY NAME <br /> a LOCAL AGENCY OTHER ARCO Products Company <br /> W <br /> ¢ ADDRESS <br /> P.O. Box 5811 sTtn:Env.Compl .Dept. San Mateo CA 94402 <br /> CrTY STATE ZIP <br /> W NAME CONTACTPERSON PHONE <br /> ZQ ARCO Products Company UNKNOWN Elaine Lavine (415) 571-2482 <br /> 2 a ADDRESS <br /> cr P .O. Box 5811 Attn: Env.Compl.Dept. San Mateo CA 94402 <br /> STREET CRY STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Z ARCO Facility # 6020 Gary L. Burgin 109 )823-4715 <br /> ADDRESS <br /> W 1711 E. Yosemite Manteca CA 95336 <br /> STREET CRY coUNTV ZIP <br /> CROSS STREET <br /> Highway 99 <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w <br /> 5 San Joaquin Env. Health Ms . Lori Cotulla X09 )468-3420 <br /> wZ <br /> REGIONAL BOARD PHONE <br /> Central Valley Region Mr . Lee Boggs ( 91� 361-5600 <br /> U) (1) NAME QUANTITY LOST(GALLONS) <br /> W <br /> ZGasoline <br /> J UNKNOWN <br /> Q <br /> w O <br /> m> (2) <br /> N Z <br /> El UNKNOWN <br /> Z DATE DISCOVERED HOW DISCOVERED INVENTORY CONTROL SUBSURFACE MONITORING E] NUISANCE CONDITIONS <br /> LU <br /> :E0M 1 D 8 D 9 v v TANK TEST a TANK REMOVAL ® OTHER D r iy e o f f <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> 0 5 1 8 9 0 UNKNOWN ❑ REMOVECONTENTS REPLACE TANK CLOSE TANK <br /> W M M D D V Y <br /> 0 HAS DISCHARGE BEEN STOPPED? REPAIR TANK REPAIR PIPING E] CHANGE PROCEDURE <br /> o D YES ❑ NO IF YES,DATE M M DI I <br /> D Y Y ® OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> aF—] TANK LEAK 0 UNKNOWN 71 OVERFILL RUPTURE/FAILURE ® SPILL <br /> �v ❑ PIPING LEAK OTHER ❑ CORROSION UNKNOWN ❑ OTHER <br /> N a CHECK ONE ONLY N/A <br /> U E] UNDETERMINED SOIL ONLY GROUNDWATER ❑ DRINKING WATER - (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Z rn <br /> F NO ACTION TAKEN a PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED POLLUTION CHARACTERIZATION <br /> cc� <br /> � F—] LEAK BEING CONFIRMED � PRELIMINARY SITE ASSESSMENT UNDERWAY � POST CLEANUP MONITORING IN PROGRESS <br /> O F—] REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTIONS) f� <br /> EXCAVATE&DISPOSE(ED) REMOVE FREE PRODUCT(FP) ENHANCED BIO DEGRADATION(IT) <br /> IgE BACK WR DETA&M <br /> 0 4 F-] CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) r,UWp&TREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) <br /> a ❑ CONTAINMENT BARRIER(CB) NO ACTION REQUIRED(NA) TREATMENT AT HOOKUP(HU) VENT SOIL(VS) <br /> VACUUM EXTRACT(VE) OTHER(OT) <br /> rn <br /> Z Customer drove off with nozzle still in car . Dealer used absorbent <br /> material to clean up spill. Station was closed during cleanup. <br /> 0 IDES and Env. Health were notified. <br /> NSC 0.5(11/69) <br /> r � / <br />