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SITE INFORMATION AND CORRESPONDENCE
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3500 - Local Oversight Program
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PR0545691
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
5/27/2020 12:00:27 PM
Creation date
5/27/2020 11:53:37 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545691
PE
3528
FACILITY_ID
FA0004068
FACILITY_NAME
GBM Manufacturing Inc.
STREET_NUMBER
1145
Direction
S
STREET_NAME
SIERRA NEVADA
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15135027
CURRENT_STATUS
02
SITE_LOCATION
1145 S SIERRA NEVADA ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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same- <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SER CES FOR LOCAL AGENCY USE ONLY <br /> REPORT BEEN FILED 9 <br /> YES NO OYES NO I HEREBY CERTIFY THATI.HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> REPORT DATE DISTRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM <br /> CASE s <br /> M MI YI r SIGNED DATE <br /> NAME OF INDIVIDUAL FILING REPORT EREGIONAL <br /> HONE TURE <br /> w REPRESENTING O OWNERIOPERATOR ORDCOMPANY OR AGENCY N E <br /> g ,u,( LOCAL AGENCY O OTHER <br /> it ADDRESS <br /> yyV`13a. - Tv, AVIE�REET <br /> E <br /> Lu NAME CrTY STATE Zip <br /> CONTACTPERSONco <br /> PHONE p� �l <br /> z Z: C.ta 1EXT O UNKNOWN <br /> a d ADDRESS <br /> U) <br /> `L S-UG�E-TOl� C4 c`STA <br /> w <br /> STREET CITr � ATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR rPH�ONE <br /> o CP, T� -C `� ) - <br /> a ADDRESS <br /> w Cm COUNTY <br /> v—i CROSS STREET zip <br /> O LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> 50^ �o to C4 A� tj I �}u E'h r D w1►1 .� C&�a r`�1•� {�{j�) .3�s <br /> wo <br /> w REGIONAL BOARD c1 PHONE <br /> w O (1) NAME QUANTITY LOST(GALLO S) <br /> J <br /> UNKNOWN <br /> t5 <br /> m (2) <br /> D� <br /> y Q UNKNOWN <br /> wA1TE DISCOVERED f� HOW DISCOVERED � INVENTORY CONTROL O SUBSURFACE MONITORING 0 NUISANCE CONDITIONS <br /> w V MI v.1 O D S D1 O O yj y r TANK TEST W TANK REMOVAL O OTHER <br /> < DATE DISCHARGE BEGAN METHOD USED TO STOP DISCH GE(CHECK ALL THAT APPLY) <br /> Q UNKNOWN O REMOVE CONTENTS CLOSE TANK&REMOVE O REPAIR PIPING f( <br /> w M M D D Y Y \VW <br /> 0 HAS DISCHARGE BEEN STOPPED? O REPAIR TANK O CLOSE TANK&FILL IN PLACE O CHANGE PROCEDURE <br /> o E/YESE] NO IF YES.DATE M M1 OilI r y O REPLACE TANK O OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) j <br /> Q s 0 TANK LEAK UNKNOWN O OVERFILL O RUPTURE/FAILURE O SPILL r <br /> y v O PIPING LEAK --j OTHER O CORROSION UNKNOWN O OTHER <br /> w w CHECK NE ONLY <br /> w a <br /> U UNDETERMINED SOIL ONLY 0 GROUNDWATER O DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> w ONO ACTION TAKEN O PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED POLLUTION CHARACTERIZATION <br /> m <br /> cc y LEAK BEING CONFIRMED O PRELIMINARY SITE ASSESSMENT UNDERWAY POST CLEANUP MONITORING IN PROGRESS <br /> U O REMEDIATION PLAN O CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) O CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) O EXCAVATE E DISPOSE(ED) O REMOVE FREE PRODUCT(FP) ENHANCED BIO DEGRADATION(IT) <br /> J (SEE BACK FCR DETALS( <br /> a ZO <br /> O CAP SITE(CD) O EXCAVATE b TREAT(ET) O PUMP d TREAT GROUNDWATER(GT)0 REPLACE SUPPLY(RS) <br /> Lu <br /> O CONTAINMENT BARRIER(CB) L_J NO ACTION REQUIRED(NA) O TREATMENT AT HOOKUP(HU) VENT SOIL(VS) <br /> cc U VACUUM EXTRACT(VE) O OTHER(OT) y <br /> F�rk►1.�(r_ �n��s-�•St �. wltl be �-e ���� . 5 ��� a�le� Cmn �►� <br /> w <br /> Are ' ( �4S � <br /> 0 <br /> 0 <br /> U <br /> HSC 05(&M <br />
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