Laserfiche WebLink
c <br />UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br />EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br />YES NO <br />STATE TANK ID a <br />REPORT BEEN FILED} II YES �, NO <br />REPORT DATE -4(- CASE # <br />REGIONAL BOARD CASE M <br />US EPA ID M <br />0M 1M 1 6 8Y 7 <br />YLOpA <br />D D <br />NAME OF INDIVIDUAL FILING REPORTPHONE <br />SIGNATURE <br />m <br />John J. DeSelm <br />( > <br />D <br />W <br />REPRESENTING Q LOCAL AGENCY LJ OTHER <br />COMPANY OR AGENCY NAME <br />W <br />[X] OWNER/OPERATOR REGIONAL BOARD <br />ANHEUSER BUSCH COMPANIES <br />1 <br />W <br />ADDRESS <br />ONE BUSCH PLACE ST. LOUIS MO 63118 <br />STREET CITY STATE ZIP <br />I> <br />_ H <br />NAME <br />CONTACT PERSON <br />PHONE <br />Z¢ <br />!� <br />Rainbo BakingCom an Q UNKNOWN <br />FrPd McPherson <br />(2()Q ) — <br />11 <br />�^W <br />ADDRESS <br />WJ <br />�m <br />2651 S. Aifpcitt Way Stockton CITY California STATE 95206 ZIP <br />FACILITY NAME (IF APPLICABLE) <br />OPERATOR <br />PHONE <br />Z <br />Rainbo Baking Company <br />Raney Thomas <br />(916 ) 456-3863 <br />a <br />ADDRESS <br />0 <br />2651 S. AlparTt Way Stockton California 95206 <br />CITY COUNTY zip <br />W <br />CROSS STREET <br />TYPE OF AREA ❑ COMMERCIAL INDUSTRIAL <br />TYPE OF BUSINESS ❑ RETAIL FUEL STATION <br />--- <br />F]RESIDENTIAL RURAL Q OTHER <br />UNKNOWN EZOTHER Bakery <br />LOCAL AGENCY AGENCY NAME <br />CONTACT PERSON <br />PHONE <br />San Joaquin Env. Health District <br />Laurie Cotulla <br />( ) <br />466-6781 <br />HZ'w <br />- <br />REGIONAL BOARD <br />'U <br />Central Valley <br />Gerald Djuth <br />(916 ) <br />W <br />wD <br />455-0270 <br />LL ¢ <br />TSCD <br />f <br />( ) <br />y1O <br />CAS I (ATTACH EXTRA SHEET IF NEEDED) NAME QUANTITY LOST IGALLONSI <br />Gasoline UNKNOW <br />ZW <br />(1)418 1 DID 1 16 I qI I <br />O <br />m>_ <br />0- <br />(2) 1 1 1 1 1 1 �4 UNKNOW <br />DATE DISCOVERED <br />HHrO',1W DISCOVERED Q INVENTORY CONTROL SUBSURFACE MONITORING <br />yH <br />M 2M 3D 00 8Y 6 Y <br />L__J ROUTINE MONITORING 0 REMOVAL C1 TANK NUISANCE CONDITIONS OTHER: F.ank LPCt <br />W <br />w W <br />. <br />DATE DISCHARGE BEGAN <br />METHOD USED TO STOP DISCHARGE IC HECKALL THAT APPLY). <br />QW <br />U <br />M M D D Y Y UNKNOWN <br />® REMOVE CONTENTS REPLACE TANK F CLOSE TANK <br />�` <br />iL ]REPAIR TANK LjREPAIR PIPING E1CHANGE PROCEDURES <br />HAS DISCHARGE BEEN STOPPED} <br />YES NO IF YES, DATE I I M 2 M III D 1 1 D 8 Y 6 Y <br />LjOT HER <br />W <br />SOURCE(S) OF DISCHARGE <br />TANKS ONLY/CAPACITY 6nnn GAL <br />CAUSE(S) <br />7 <br />TANK LEAK UNKNOWN <br />OVERFILL Q CORROSION <br />¢ <br />AGE (y YRS. ® UNKNOWN <br />U <br />W <br />l <br />l_l PIPING LEAK <br />MATERIAL <br />'.I RUPTURE/ FAILURE SPILL <br />U <br />STEEL FIBERGLASS <br />_j <br />L -i <br />ON <br />'J OTHER(SPECIFY) <br />OTHER. <br />aUNKNOWN OTHER <br />RESOURCES AFFECTED YES NO THREATENED UNKNOWN <br />WATER SUPPLIES AFFECTED HR <br />ENED KNOWN WELLS <br />Fl <br />AIR (VAPOR) r� ® rr LJ ,, � <br />J - <br />YES NO <br />PUBLIC DRINKING - ff <br />U <br />W <br />SOIL IV HOOSE ZONE)ILEA <br />17 <br />WATER <br /><n <br />GROUNDWATER 11 O Cl <br />Wq ERATE DRIN KING ['_; (�1 I1 lil <br />W <br />SURFACE WATER OR STORM GRAIN E-] X U C7 <br />tC^1 <br />INDUSTRIAL � I <br />2~ <br />BUILDING OR UTILITY VAULT 71/ O <br />AGRICULTURAL a _ <br />O,¢ <br />OTHER (SPECIFYI LJ O Q LJ <br />OTHER IS PECIF VI 0 EJ ED 0 <br />w <br />GROUNDWATER BASIN NAME <br />0: <br />UNKNOWN <br />COMMENTS: <br />Action lan will be submitted to the San Joaquin Env. Health District by January 23, <br />Z <br />1987. I groundwater is becomes affected, the Regional Board will be informed. <br />W <br />F <br />O <br />U <br />COMPLETE AND ATTACH A CLEANUP TRACKING REPORT IF ANY CLEANUP WORK OR PLANNING HAS STARTED NSC 05 110/65I <br />