UAR/PROP 65_PRE 2019 - Laserfiche WebLink

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7W 9 UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES STATE TANK ID: ❑ YES [M NO REPORT BEEN FILEDT ❑ YES NO REPORT DATE LOCAL CASE # REGIONAL BOARD CASE # US EPA ID# OM 1M 1 D16 D 8yj 7 Y NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE nn John J. DeSelm 1(314 h D REPRESENTING ❑ LOCAL AGENCY ❑ OTHER COMPANY OR AGENCY NAME W O ® OWNER/OPERATOR ❑ REGIONAL BOARD ANHEUSER BUSCH COMPANIES W ADDRESS ONE BUSCH PLACE ST. LOUIS MO 63118 STREET CITY STATE ZIP I> NAME CONTACT PERSON PHONE _f �¢D< UNKNOWN ( )Rainbo Baking Company - a Hyl ADDRESS Wm 2651 S. Aifpatt Way Stockton CITY CaliforniaSTATE 95206 ZIP FACILITY NAME (IF APPLICABLE) OPERATOR PHONE o Rainbo Baking Company Rane Thomas ( 916 ) 456-3863 < ADDRESS 2651 S. AjrparTt Way Stockton CITY California COUNTY 95206 zip F I CROSS STREET TYPE OF AREA ❑ COMMERCIAL ❑INDUSTRIAL TYPE OF BUSINESS ❑ RETAIL FUEL STATION w --- RESIDENTIAL RURAL ❑OTHER Ej UNKNOWN OTHER Bakery LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE San Joaquin Env. Health District Laurie Cotulla 0 ) i„ - ZW REGIONAL OARD Central Valley Gerald Djuth (916 ) 455-0270 WW W_ WW M a TSCD W CAS# (ATTACH EXTRA SHEET IF NEEDED) NAME QUANTITY LOST (GALLONS) iW Gasoline UNKNOW <> (1) J NO m> �UNKNOW �= 121 DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING jF M 2m, M 3D DD 8V 6 Y ❑ ROUTINE MONITORING ❑ TANK REMOVAL ❑ NUISANCE CONDITIONS X] OTHER: tank tPSt ,W DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) OW M MI O D Y Yj LEM UNKNOWN ® REMOVE CONTENTS ❑ REPLACE TANK ❑CLOSE TANK U� J pm HAS DISCHARGE BEEN STOPPED? REPAIR TANK ❑REPAIR PIPING ❑CHANGE PROCEDURES < YES NO IF YES, DATE 11 M12 M DI 1 D18 y 6 Y ❑OTHER W SOURCE(S) OF DISCHARGE TANKS ONLY/CAPACITY Fnnn GAL CAUSES) j "TANK LEAK ❑ UNKNOWN I 1 ❑OVERFILL D CORROSION < AGE W YRS. ® UNKNOWN W ❑PIPING LEAK MATERIAL [:]RUPTURE/FAILURE E]SPILL U STEEL ❑FIBERGLASS ON F-1 OTHER (SPECIFY) E]OTHER UNKNOWN ❑OTHER \ RESOURCES AFFECTED YES NO THREATENED UNKNOWN WATER SUPPLIES AFFECTED ENED KNOWN WELLS D VES NO W AIR (VAPOR) ❑ 00 ❑ Ll PUBLIC DRINKING ❑ ❑ ❑ WATER W SOIL(VADOSE ZONE) W ElED ❑ PRIVATE DRINKING ❑ ❑ ❑ <Y GROUNDWATER ❑ ❑ EJ ® WATER ��----II VN WO-a, SURFACE WATER OR STORM DRAIN ❑ ❑ E] INDUSTRIAL El E::] L_1 ® —� Rs BUILDING OR UTILITY VAULT ❑ El I--] AGRICULTURAL 11 E] El p OTHER (SPECIFY) El ❑ ❑ 1--] OTHERISPECIFY) ❑ ❑ ❑ ❑ ZW GROUNDWATER BASIN NAME UNKNOWN COMMENTS: Action plan will be submitted to the San Joaquin Env. Health District by January 23, z 1987. If groundwater is or becomes affected, the Regional Board will be informed. f E 0 u \ COMPLETE AND ATTACH A CLEANUP TRACKING REPORT IF ANY CLEANUP WORK OR PLANNING HAS STARTED .i+C 05 (10/85)