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UNDERGROUND STORAGE TANK UNAUTHORIZED RELtkSt5('ffAkf-.-j,'d KTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR <br /> ................. <br /> LOCALAGENCY USE ONLY. <br /> AKI A'r t: <br /> AEPORT BEEN FLED? :.THERIEW 7MTlF.Y::T L <br /> YES NO ❑YES NO A:DESUMT.Egi�POVERNY��...'�MF!�Oy��:AND:THR 1: <br /> ❑ :...REPORTED:;THIS::�INFORMATM:�TO:'LocAL����wr,.fALs..:P.um.ANT.,:.T.o.:��.%SECTION 1.OF <br /> .......... . ......:...,.....; r....r..r.l....... - - . . - <br /> REPORT DATE CASE 0 ;THEHEAUN ANDSAFTY, .................... <br /> ...................................... <br /> .................... <br /> ........................... <br /> ........... <br /> I ml 0 ml 0 4 8 yl 9 <br /> NAME OF INDIVIDUAL FILING REPORT PHONE I SIGN RE <br /> Jerry Cates ( 209) 462-1100 <br /> 0 REPRESENTING 10 OWNERIOPERATOR E] REGIONALROARD COMPANY OR AGENCY <br /> 0 ❑ LOCAL AGENCY E:j OTHER 7 City of Stockton <br /> ADDRESS <br /> 1465 S. Lincoln Street Stockton Ca 95206 <br /> STREET a" i STATE zfp <br /> NAME CONTACT PERSON PHONE <br /> Cit Of Stockton ❑ UNKNOWN <br /> Jerry 'ZAtes (209 ) 462-1100 <br /> R a ADDRESS <br /> 1465 S. Lificoln Street Stockton CA 95206 <br /> STREET h CITY STATE zi <br /> FACILITY NAME(IF APPLICABLE) PERATOR PHONE <br /> Building victory Park Maintenance ildin�� -TO McClellan Terry (209 ) 944-8341 <br /> ADDRESS <br /> San Joaquin <br /> e t i Stockton Ca 95204 <br /> Argonne/Picardy i� erry 1 .1 - cmw" p <br /> OF AREA [:D COMMERCIAL❑INDUSTRIAL❑RURAL TYPE OF BUSINESS E::] RETAIL FUEL STATION <br /> CROSS STREET TYPE E::] <br /> Picardy RESIDENTIAL [::]OTHER FARM OTHER Government <br /> LOCAL AGENCY AGENCY NAME OONTACT PERSON PHONE <br /> M <br /> San Joaquin Health District (209 ) 468-3432 <br /> tu <br /> 2w REGIONAL BOARD PHONE <br /> w <br /> NAME QUANTITY LOST(GALLONS) <br /> LU 100 ❑ UNKNOWN <br /> Unleaded gasoline <br /> (2) <br /> El UNKNOWN <br /> DATE DISCOVERED HOWDISCOVERED M INVENTORY CONTROL a SUBS.URFACG MONITORING ❑ NuEANcEcoNDITIONS <br /> 2 0 ml 9 ml 2 01 5,1 8 y1 97, = TANK TEST F7 TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> LU <br /> 0 l 8 ,12 -DOD8 9 , E:l UNKNOWN REMOVE CONTENTS ❑ REPLACE TANK ❑ CLOSE TANK <br /> - 1 I 1 1 <br /> HAS DISCHARGE BEEN STOPPED? ❑ REPAIR TANK ❑ REPAIR PIPING F❑ CHANGE PROCEDURE <br /> o YES E] NO F YES.DATE 0.1 9 ml 2 ,16 1 8 19 OTHER <br /> SOURCE OF DISCHARGE TANKS ONLYiCAPACITY MATERIAL " CAUSE(S) <br /> F7 TANK LEAK [X4 UNKNOWN 356 GAL ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE <br /> fI <br /> PIPING LSM AGE YRS STEEL ❑ CORROSION UNKNOWN <br /> ❑ OTHER Q�j UNKNOWN ❑ OTHER SPILL ❑ OTHER <br /> LU it CRECKONEONLY <br /> UNDETERMINED ❑ SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY F WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> z <br /> w SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> F--j NO ACTK)N TAKEN [:] POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVA'LABLETO PROCEED [:] EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> 9z ❑ CAP SITE(CD) ❑ <br /> EXCAVATES DEPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO OEGRADATION(ln <br /> LU <br /> 2 PLIMP&TREATGROUNDWATER(GT) ❑ REPLACESUPPLY(RS) <br /> CONTAINMENT BARRIER(CB) ❑ EXCAV ATE&TREAT(ET) ❑ <br /> ❑ TREATMENT AT HOOKUP(HU) E] NO ACTION REQUIRED(NA) ❑ OTHER(0ii,) <br /> LU <br /> 2 <br /> HSC 05(Amn <br />