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UNDERGROUND STORAGE TANK. UTHORIZED RELEASE (LEAK)/CO INATION SITE REPORT <br /> STATE TANK ID = <br /> ` HAS STATE OFFICE OF EMERGENCY SERVICES <br /> YES NO REPORT BEEN FILED? ❑ YES Li NO 6 <br /> -BORT DATE LOCAL CASE < REGIONAL BOARD USE . us EP 10 11 <br /> 9152414 <br /> 0 2 M 1p1 2DI 8Y1 6 Y <br /> NAME OF INDIVIDUAL FILING REPORT PHONE NATURE <br /> Marvin G. Palmer ( 209 ) 946-5462 <br /> REPRESENTING I_ I LOCAL AGENCY (_I OTHER COMPANY OR AGENCY NAME <br /> 'I XI OWNER/OPERATOR �� REGIONAL BOARD American Forest Products Company <br /> ADORES CA 95205 <br /> 1800 Marshall Avenue Stockton <br /> STREET CITY STATE ZIP <br /> CONTACT PERSON PHONE <br /> " NAME ( 209 ) 946-5462 <br /> American Forest Products Co. ❑ UNKNOWN Marvin G. Palmer <br /> I <br /> 205 <br /> A]D?8t�751iarshall Avenue Stockton T 95ZIP <br /> STREET CITU STATE ZIP <br /> FACILITY NAME OF APPLICABLE) OPERATOR PHONE <br /> American Forest Products Company same ( 209 ) 946-5462 <br /> ':�ORL'=_ Stockton San Joaquin 95205 <br /> 1800 Marshall Avenue CITY COUNTY ZIP I <br /> STREET ����rT�lI <br /> CROSS STREET TYPE OF AREA LJ COMMERCIAL ��INDUSTRIAL TYPE OF BUSINESS ❑ RETAIL FUEL STAT <br /> RESIDENTIAL <br /> RURAL ❑OTHER C)UNKNOWN ®OTHERWood Products <br /> Harding Way LXJ - <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> San Joaquin Local Health District Jim Miller ( 209 ) 466-6781 <br /> REGIONAL BOARD <br /> ( ) <br /> TSCO <br /> ( ) <br /> GLIA NTITY !.OST (GALLONS) <br /> -�—CAS / (ATTACH EXTRA SHEET IF NEEDED) NAME <br /> Chevron Diesel Fuel 112 UNKNOW.. <br /> r • I� UNKNOWN <br /> (ZI 1 <br /> DATE DISCOVERED HOW DISCOVERED U INVENTORY CONTROL (l SUBSURFACE MONITORING Subsurface <br /> QQ rr TANK I NUISANCE CONDITIONS OTHER: Testing <br /> DM, 1 m,00, `b� 8Y, 6 Y 7[ ] ROUTINE MONITORING ❑ REMOVAL — <br /> 04TE ."•CHARGE BEGAN E <br /> ETHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) <br /> M M: DI C; v' YI [ ) UNKNOW ] REMOVE CONTENTS I REPLACE TANK '.CLOSE TANK <br /> q, HAS (711 MARGE I FF:N STOPPED' (REPAIR TANKI-jREPAIR PIPING ', ICHANGE PROCEDURES <br /> ;X'VES IND If YES, DATE OMI 1M 1 D 0 )OTHER <br /> �Ul!q< t 51 OF DISCHARGE. TANKS ONLYICAPACITY 10.000 GAL CAUSE(S) <br /> I UNKNOWN <br /> ;TANK LEAN I I LjDVERF;L:_ _ rn PR,nLIIIN <br /> AGE W YRS. (X�� UNKNOWN <br /> MATERIAL RUPTURE/FAILURE '._ (SPILL <br /> x PIPING LEAK ®STEEL ❑ FIBERGLASS <br /> OTHER ❑UNKNOWN L IOTHFR <br /> j OTHER IS PECIFYI ❑ <br /> WATER SUPPLIES AFFECTED <br /> RESOURCES AFFECTED YES NO THREATENED UNKNOWN YES NO ENED KNOWN WELL` <br /> I:�] X) 11 _ PUBLIC DRINKING <br /> AIR IVAPOR) ^ WATER LJ l <br /> SOIL (VADOSE ZONE) n ❑I`' L_� I-) PRIVATE DRINKING n FY <br /> GROUNOWATr- h lrl I_ 1 ;-, WATER <br /> AVN) A. 1 WAII 1: I+ 4 S` +M ^RAIN ( `en I_J I _ INDUSTRIAL I I CI <br /> ,.I n:• } OR UTILITV VA:. T 1 Lrpp�,l 1l_L-1�� I AGRICULTURAL (� X <br /> E ` <br /> AIOIHLRISP <br /> CIF.1 L_j (_l OTHER(SPECIFY) X1 LJ <br /> I GROUNDWATER BASIN NAME <br /> UNKNOWN <br /> C OMNCN TS: <br />