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UAR/PROP 65_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231345
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
5/20/2019 1:51:31 PM
Creation date
10/11/2018 2:56:57 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0231345
PE
2381
FACILITY_ID
FA0003713
FACILITY_NAME
CHEVRON #95775 MCCOMBS* (INACT)
STREET_NUMBER
301
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04514002
CURRENT_STATUS
02
SITE_LOCATION
301 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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KBlackwell
Tags
EHD - Public
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08/28/98 14:45 $`510 842 8370 CHEVRON L'. S,A, zo05; 009 <br />UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (L-EAK) f CONTAMINATION -SITE -REPORT - - <br />EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br />REPORT BEEN FILED 7 <br />FOR LOCAL AGENCY USE ONLY <br />ED res �No ❑ YES No <br />I HERESY CERTIFY THAT i HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br />DISTRIBUTION SHOWN ON THE• INSTRUCTION SHEET ON THE BACK PAGE OF TM' FOR m, <br />REPORT DATE <br />CASE s <br />O � d <br />SCAU OAT <br />NAME OF INDIVIDUAL FILING REPORT <br />PHONE <br />SIGNATURE <br />m <br />✓J �_� <br />�r Q <br />("l �5 Ui �,-13Lqq <br />REPRESc'NTINGOWNE WOPERATOR (� REGIONAL BOARD <br />COMPANY OR AGENCY NAME <br />d <br />L <br />CI LOCALAGENCY [::] OTNER i <br />t'\C' V Cor (� C �S CC V'Yl ` <br />¢ � <br />ADDRESS <br />?-0. Box Gooy San Ra, or, cA, CtLi3.090�{ <br />, <br />STREET <br />W j <br />GRY 3TATE Yiv <br />NAME TACT PE PHONE <br />�i�EVfp,T �fOG�VC S �p. <br />UNKNOWN �re v �� (925) `III �5 <br />a < ADDRESS <br />0. <br />R-CtmOr� C I� - � 5 � 3 -o5o4 <br />3'IAEEr CITY STATE Z.0 <br />FACILITY NAME (IP APPLICABLE) <br />Chevron SefvlCe S�q�lon <br />OPERATOR, PHONE <br />C1;,fvron trodvcA-S <br />o, <br />COmfony (R9,5)SLiZ-f5 Q5 <br />ADDRESS <br />3Ut Wes-- Y-t-i0e-mcAf\ Lane �Ul�i Scan .�O�iS(('(>l C,52.H0 <br />SYRCCT GT' CO ,0 <br />CROSS STREET <br />Le.e <br />p <br />LOCAL AGENCY NAME CONTACTPERSON PHONE <br />}AGENCY <br />s <br />SAn4OIL aUi�j l.Pv'1�y! [E}S'EAD �0.rflrl KY101� 44p0 -3'{y1 <br />w <br />REGIONAL BOARD <br />PHONE <br />CeItI-clI Volley R1n/0(-6 <br />V) <br />U <br />2 O <br />y <br />(1) j 1 D If {j NAME OUANTITY LOST (GALLONS) <br />Ue1ICYt ,pa Gasoline UNKNOWN <br />a 1 <br />m > <br />R1 <br />h <br />UNKNOWN <br />DATE DISCOVERED ( HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONOrTIONS <br />Zo �rlY ❑ ❑ <br />lb � TANK TEST TANK REMOVAL OTHER ©NI <br />Zi M o <br />m <br />DATE DISCHARGE BEGAN <br />METHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) <br />4 <br />W <br />•��{' <br />UNKNOWN <br />❑ REMOVE CONTE NTS.J�CLOSE TANK L REMOVE ❑ REPAIR PIPING <br />0HAS <br />0 <br />DISCHARGE BEEN STOPPED 7 <br />!� <br />C REPAIR TANK F-1CLOSE TANK 6 FILL IN PLACE !� CHANGE PROCEDURE <br />U <br />O <br />YES ❑ NO IF YES. DATE pu' uI o o� (] Y v <br />1 <br />❑ REPLACE TANK ❑ 07NER <br />SOURCE OF DISCHARGE <br />CAUSES) <br />j❑ <br />TANK LEAK UNKNOWN <br />❑ OVERFILL AUPTUIRE/FAILURE ❑ SPILL <br />In <br />❑ PIPING LEAK 0 OTHER <br />.�❑y <br />❑ CORROSION UNKNOWN ❑ OTHER <br />•�^ <br />wa <br />CHECK ONE ONLY <br />KN <br />V <br />E71 UNDETERMINED , SOIL ONLY GROUNDWATER D DRINKING WATER • (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br />CHECK ONP ONLY <br />2 0 <br />a NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SU13MrTTEO POLLUTION CHARACTERIZATION <br />j H <br />LEAK BEING CONFIRMED PRELWINARY S(TE ASSESSMENT UNCERWAY O POST CLEANUP MONITORING IN PROGRESS <br />U <br />REMEDIATION PLAN F7 CASE CLOSED (CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UNDERWAY <br />� <br />CHECK APPROPRIATE ACTION(S) EXCAVATES DISPOSE (ED) ❑ REMOVE FREE PRODUCT (FP) ❑ ENHANCED 910 DEGRADATION (IT) <br />,moi sex ev oeT�a.-� <br />aO <br />00 <br />CAP SITE (CD) r7EXCAVATE & TREAT (ET) F7 PUMP 6 TREAT GROUNDWATER (GT) ❑ REPLACE SUPPLY (RSI <br />w < <br />F CONTAINMENT BARRIER (CBj NO ACTION REQUIRED (NA) TREATMENT AT HOOKUP (HU) VENT SOIL (VS) <br />cf <br />❑ VACUUM EXTRACT (VE) ❑ OTHER (OT) <br />((-- <br />�fC`(m(nG�rY S;�c aSSCSSr7Pn} P?40,me(k �0 dr-CI,f- vc-+Ic0, 17 0 <br />W <br />SC,� CC n�RT"Iln.l� It"I $,er Ceder - Rya^ cc-+ngfn(y -)c.rK floc s: c4c- <br />J <br />� <br />8 <br />f <br />L`m,��pl 1 �r+dv.., 0� SoU�Ce Y"'ie i "O by eyCaTVe,4fen, i I?4CrWZPP} On <br />H3c w laws <br />
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