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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) 1 CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES >:: <br /> YES =X NO REPORTBEENFILED 7 1M1Rf*11� 1I1� lVLlti!rlilliR�Y' L �NIfNI`E#RpLdIRAI©1 {AT1 <br /> = 0 NES 0 tiRit .# #+i# #7: 1 1 # SAE a".i S1tRAir O Sr:CraON> <br /> ....... . . . <br /> ..... <br /> REPORT DATE(MM-DD-YY) CASE# <br /> 04/01/91 <br /> 16240 ..... .,:. :..:::::::.:::.:.:..::.. :......... <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SiG TUR <br /> ED Elaine Lavine (415)-571-2482 u <br /> o REPRESENTING =X OWNERKOPERATOR =REGIONAL BOARD COMPANY OR AGENCY NAME <br /> o =OTHER OTHER ARCO Products Company <br /> ADDRESS P.O. Box 5811 San Mateo CA 94402 <br /> STREET CITY STATE ZIP <br /> NAME CONTACT PERSON PHONE <br /> FA Q ARCO Products Company =UNKNowN Elaine J.Lavine (415)-571-2482 <br /> o CA 94402 San Mate <br /> ADDRESS <br /> 95a PO BOX 5811 ATTN: Env.Compl.Dept. CITY STATE ZIPSTREET <br /> FACILITY NAME OF APPLICABLE) OPERATOR PHONE <br /> o ARCO FACILITY 02076 LJ S ENTERPRISE INC (209)-334-3678 <br /> U ADDRESS 800 EAST KETTLEMAN LA LODI SAN JOAQUIN 95240 <br /> OJ STREET CITY COUNTY ZIP <br /> LU <br /> t: CROSS STREET <br /> HWY 99/E KETTLEMAN LN <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> z COUNTY OF SAN JOAQUIN-OFFICE OF (209)-468-3969 <br /> w w REGIONAL BOARD PHONE <br /> Q CENTRAL VALLEY REGION LEE BOGGS (916)-361-5600 <br /> (1) NAME QUANTITY LOST(GALLONS) <br /> J GASOLINE UNKNOWN <br /> O (2) QUANTITY LOST(GALLONS) <br /> mUNKNOWN <br /> DATE DISCOVERED(MM-0D-YY) HOWDISCOVERED =INVENTORY CONTROL =SLIBSURFACE MONITORING =NUISANCE CONDITIONS <br /> 03/29/1991 =TANK TEST =TANKREMOVAL =OTHER DRIVE OFF <br /> Er Z <br /> >w DATE DISCHARGE BEGAN(MM-0D-YY) METHOD USED TO STOP DISCHARGE(CHECKALL THAT APPLY) <br /> 0 w 03/29/1991 �1NKNOWN REMOVE CONTENTS = REPLACE TANK =CLOSE TANK <br /> a¢ HAS DISCHARGE BEEN STOPPED? = REPAIR TANK = REPAIR PIPING =CJiANGE PROCEDURE <br /> 0 YES =NO IF YES,DATE 03/29/1991 0 OTHER SHUT OFF PUMP <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> Uj <br /> Q =TANK LEAK = UNKNOWN = OVERFILL =RUPTUREIFALURE SPILL <br /> RU =PPNG LEAK =X OTHER CORROSION UNKNOWN =x OTHER DRIVE OFF <br /> w w CHECK ONE ONLY <br /> CO <br /> U ®UNDETERMINED =SOL ONLY =GROUNDWATER =DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Uj NO ACTION TAKEN PREUNlNARY SITE ASSESSMENT WORKPLAN SUBMITTED POLLUTION CHARACTERIZATION <br /> cc� <br /> ¢ O LEAKBEING CONFIRMED Q PRELIMINARY SITE ASSESSMENT UNDERWAY Q POSTCLEANUP MONITORING IN PROGRESS <br /> U c = REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) =CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) =EVACUATE AND DISPOSE(ED) =REMOVE FREE PRODUCT(FP) =ENHANCED BIO DEGRADATION(IT) <br /> w O =CAP SITE(CD) =EVACUATE AND TREAT(ET) =PUMP&TREAT GROUNDWATER(GT) =REPLACE SUPPLY(RS) <br /> CONTAINMENT BARRIER(CB) 0 NOACTION REQUIRED(NA) =TREATMENT AT HOOKUP(HU) =VENTSUPPLY(VS) <br /> =VACUUM EXTRACT(VE) =OTHER(OT) <br /> Cn CUSTOMER DROVE OFF WITH NOZZLE IN CAR. SPILL WAS CLEANED UP WITH ABSORBENT MATERIAL. FIRE <br /> LU <br /> DEPT. RESPONDED. PUMP WAS REPAIRED. SAN JOAQUIN COUNTY AND OES NOTIFIED. <br /> ON <br /> APR b <br /> 4'`` tt 9 1 <br /> LI\1VIII �VI..I�Y1N tiJ <br />