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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FQR LOCAt;'AGENCX USE ONLY <br /> ❑ YES ® NO REPORT BEEN FILED Z <br /> )HEREB5ICERTIFYTHATI HAVE:DISTRIBUTEDTH151NFOHMli7fONAC(�MHDfNCsTQTHE <br /> YES �NO ,. <br /> (lISTRFJ.T.K14 THE INSTAU ION SHEET ON THE BACK PAGE Of THIS FARM <br /> REPORT DATE CASE a <br /> 0 6 2 5 9 6 014.4_Q8 <br /> M M V <br /> DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIG E <br /> Barbara F. Todd (714 ) 428-6569 <br /> REPRESENTINGOWNER/OPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAffEr <br /> S ❑ LOCAL AGENCY M OTHER Unocal Corporation <br /> LU <br /> ADgBFSs Anton Blvd. , Rm. 9009 Costa Mesa California 92626 <br /> STREET CITY STATE ZIP <br /> J NAME CONTACTPERSON PHONE <br /> z cc Unocal Corporation ❑ UNKNOWN I Barbara F. Todd � ( 714) 428-6569 <br /> OCL N <br /> W a ADDRESS <br /> 555 Anton Blvd. , Rm. 9009, Costa Mesa California 92626 <br /> STREET CRY STATE 711p <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> o Unocal Service Station #5886 Darrell Eppler ( 209) 473-733 <br /> a ADDRESS <br /> W 2701 W. March Lane, Stockton, San Joaquin 95207 <br /> y ZIP <br /> CROSS STREET <br /> I - 5 <br /> C5 LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> Ww San Joaquin Cnty. , Env. Health Michael Kith ( 209) 468-342 <br /> LU <br /> REGIONAL BOARD PHONE <br /> as <br /> W (�) NAME QUANTITY LOST(GALLONS) <br /> Ow w Petroleum Hydrocarbons (Gasoline) C� UNKNOWN <br /> J <br /> 229 (2) <br /> �— <br /> y <br /> ❑ UNKNOWN <br /> r- DATE DISCOVERED HOW DISCOVERED <br /> Z ❑ INVENTORY CONTROL E] SUBSURFACE MONITORING E:] NUISANCE CONDITIONS <br /> OM 6 .1 2 ,1 l0 9 Y 6 Y ❑ TANK TEST ❑ TANK REMOVAL OTHER Changing dispenser filt rs <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> 0 6 M1 2 1 01 9 Y 6 Y ❑ UNKNOWN ❑REMOVE CONTENTS ❑CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> $ HAS DISCHARGE BEEN STOPPED 7 ❑REPAIR TANK ❑CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> a YES ❑ NO IF YES,DATE 0.16 2 .1 1 d 9 yj 6 Y ❑REPLACE TANK ®OTHER Cut power to pumps- <br /> SOURCE OF DISCHARGE CAUSE(S) then reset impact valve. <br /> =a ❑ TANK LEAK ❑ UNKNOWN I ❑ OVERFILL ❑ RUPTURE/FAILURE DM SPILL <br /> yU ❑ PIPING LEAK OTHER Dispen eF-] CORROSION ❑ UNKNOWN ❑ OTHER <br /> a a CHECK ONE ONLY Containment box beneath dispenser and concrete <br /> V ❑ UNDETERMINED ❑ SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY See Comments <br /> ❑ NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS <br /> V ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY ` <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED 810 DEGRADATION(IT) <br /> Z (SEEencu ran MARS( <br /> ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) C <br /> w0 <br /> a ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ❑ VACUUM EXTRACT(VE) OTHER(OT) See Comments <br /> Contractor cleaned up approximately 8 gallons of fuel- 5 gallons in <br /> w containment box & `2--3 gallons that spilled on concrete. <br /> CX <br /> r"C�, _ 1 n_ HSC 05(890) <br />