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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) ! CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br /> REPORT BEEN FILED? 1 F1 $i1?:i ?E: R1`4iRIVI AiE�'CI1 E#� LOl Jif ID tS?#t' <br /> YES =X NO <br /> =x )Es pro tsisalxs sr t tc s>: Yagi . <br /> REPORT DATE(MM-0D-YY) <br /> 16240 ?..:::::::::::::::.:: :::::.::::::.:::::::::::::::.::::,::::.::. � T : <br /> 04/01/91 <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE <br /> Elaine Lavine (415)-571-2482 <br /> o REPRESENTING =X OW EROPERATOR =REQ BOARD COMPANY OR AGENCY NAME <br /> �OCALAGENCY =pTHEq ARCO Products Company <br /> O <br /> ADDRESS P.O.Box 5811 San Mateo CA 94402 <br /> STREET CITY STATE ZIP <br /> LLIJ NAME CONTACT PERSON PHONE <br /> Fn Q ARCO Products Company =UNKNOWN Elaine J.Lavine (415)-571-2482 <br /> o <br /> ADDRESS <br /> �s a PO BOX 5811 ATTN: Env.Compl.Dept. San Mateo CA 94402 <br /> STREET CITY STATE ZIP <br /> FACILITY NAME OF APPLICABLE.) OPERATOR PHONE <br /> z ARCO FACILITY 02076 ILJSENT ERPRISE INC--7 (209)-334-3678 <br /> 0 <br /> U ADDRESS 800 EAST KEITLEMAN LA LODI SAN JOAQUIN 95240 <br /> OJ STREET CITY COUNTY 71P <br /> w <br /> I-- CROSS STREET <br /> HWY 99/13 KETTLEMAN LN <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w co <br /> L COUNTY OF SAN JOAQUIN-OFFICE OF (209)-468-3969 <br /> w w REGIONAL BOARD PHONE <br /> CEN'T'RAL VALLEY REGION LEE BOGGS (916)-361-5600 <br /> � (�) NAME QUANTITY LOST(GALLONS) <br /> a> GASOLINE UNKNOWN <br /> 1 O (2) QUANTITY LOST(GALLONS) <br /> m UNKNOWN <br /> DATE DISCOVERED(MM-0D-YY) HOWDISCOVERED M/ENTORY CONTROL =SUBSURFACE MONITORING =NUISANCE CONDITIONS <br /> 03/29/1991 =TANK TEST =TANKREMOVAL =OTHER DRIVEOFF <br /> Z <br /> j W DATE DISCHARGE BEGAN(MM-0D-YY) METHOD USED TO STOP DISCHARGE(CHECKALL THAT APPLY) <br /> 00 w 03/29/1991 [D-NKNOWN a REMOVE CONTENTS REPLACE TANK CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED? a REPAIR TANK REPAIR PIPING =CHANGE PROCEDURE <br /> a YES =NO IF YES,DATE 03/29/1991 0 OTHER SHUT OFF PUMP <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> 2W =TANK LEAK Q UNKNOWN OVERFILL 0 RUPTURE/FAILURE SPLL <br /> �0 =PIPING LEAK =X OTHER CORROSION UNKNOWN =x OTHER DRIVE OFF <br /> LU w CHECK ONE ONLY <br /> U>-® UNDETERMINED SOL ONLY =GROUNDWATER DRNKNG WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> - CHECK ONE ONLY <br /> Z NO ACTION TAKEN PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED POLLUTION CHARACTERIZATION <br /> Cr <br /> cc < EING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY =POSTCLEANUP MONITORING IN PROGRESS <br /> LEAK B <br /> REMEDIATION PLAN Ej] 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 /> 00 =CAP SITE(CD) EVACUATE AND TREAT(ET) =PUMP&TREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) <br /> �a <br /> 0 CONTAINMENT BARRIER(CB) =X NOACTION REQUIRED(NA) Q TREATMENT AT HOOKUP(HU) =VENT SUPPLY(VS) <br /> =VACUUM EXTRACT(VE) Q OTHER(OT) <br /> co CUSTOMER DROVE OFF WITH NOZZLE IN CAR. SPILL WAS CLEANED UP WITH ABSORBENT MATERIAL. FIRE <br /> Z DEPT. RESPONDED. PUMP WAS REPAIRED. SAN JOAQUIN COUNTY AND OES NOTIFIED <br /> W <br /> yg "k r <br /> OAPR <br /> U <br /> J ! <br /> ENVIRONMENTAL HEAL I N <br /> t�E,�MI <br />