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UNDERGROUND STORAGE T UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES R t,OCA AGENGY.:USE ONLY <br /> REPORT BEEN FILED? <br /> ❑ YES TE NO YES ❑ No8HE(iEBYCERTlFYTHAT4 MAVEDjSTRIBUTEDTHt51NEC1AMAT) AOCORDING70TME <br /> DISTFi1BUTt0AF SHOWN ON NNE>PI$TAUCTiON SHEET ON THS BACK PAGE Of 7 HIS FORM. <br /> REPORT DATE CASE A <br /> 0. OES,010617If <br /> S.IGp. BATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SI flE <br /> r Lynda S. Chalom 1 (714 )572-7589 <br /> ca <br /> REPRESENTING El� OWNER/OPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME <br /> R ElLOCAL AGENCY F-1OTHER Unocal Corporation <br /> cc ADDRESS <br /> 2929 East Imperial CITY STATE Highway, Room 2106 Brea, California 92621 <br /> LU J NAME CONTACTPERSON PHONE <br /> Na D Roc al Cor oration ❑ UNKNOWN Edward Halston p10 )277-2311 <br /> Ui <br /> 2000 Crow Canyon Place, Suite 400 San Ramon California 94583 <br /> Y STREET CITY STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR pp{ <br /> Z Unocal Service Station 05886 Darrell Eppler ( ��9) 473-7337 <br /> 0 <br /> U ADDRESS <br /> 9 2701 West March W e Stockton, California 95207 <br /> CITY COUNTY ZIP <br /> y CROSS STREET <br /> I-5 <br /> z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> WU San Joaquin County Public Health Ron Rowe(209) 468-034 09 )468-3420 <br /> w uj REGIONAL BOARD PHONE <br /> CLs <br /> co NAME QUANTITY LOST(GALLONS) <br /> OW Ballast Nater <br /> O **Refer Delta' RlapexrtUNKNOWN <br /> DZ dated 10/25/95 for quantity** <br /> y ® UNKNOWN <br /> z DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ® SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> IMI 0M 2® 30 9Y 5Y ❑ TANK TEST ❑ TANK REMOVAL ® OTHERTrenching equipment <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPL k <br /> a <br /> UJ 1 0 2 3 0 9 Y 5 Y UNKNOWN REMOVE CONTENTS : � CLOSE TANK&REMOVE F__]REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED? ❑REPAIR TANK ®CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> 8 ® YES ❑ NO IF YES.DATE ]� 04 2 .1 3d 9YI 5y, ❑REPLACE TANK ❑OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> a M TANK LEAK ❑ UNKNOWN ® OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> cO ❑ PIPING LEAK ❑ OTHER ❑ CORROSION ❑ UNKNOWN ® OTHEFPuncture <br /> Lu n. CHECK ONE ONLY <br /> U ❑ UNDETERMINED ® SOILBWK rs GROUNDWATER ❑ DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> w ❑ NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED O POLLUTION CHARACTERIZATION <br /> Q <br /> ❑ LEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY ® POST CLEANUP MONITORING IN PROGRESS <br /> o ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ® CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S)o>:eAas' a EXCAVATE 6 DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> z <br /> ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> I= <br /> ❑ CONTAINMENT BARRIER(CB) NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ® VENT SOIL(VS) <br /> ❑cc VACUUM EXTRACT(VE) '� OTHER(OT) Will be based on preliminary site assessment <br /> find gs <br /> Full report from Delta Environmental will be submitted to your <br /> LU <br /> office no later than 10/27/95. <br /> 8 <br /> HSC 05(ems <br />