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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) 1 CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES L1.A `Yf1 .. <br /> F;F30RTBEENFILED? Et1L El 4`. #� tt�1 tiR�IintC Stl�il�iR t?�I�� �VFPItIS AAS ?fJk#3 <br /> p <br /> YES px No =x pro tu>v < +iscsv► ts �ssuA !tosci <br /> EFFORT DATE M-0D YY) CASE � :.•:::::::::::::::::::::.,..�:::::::::::::<::::.::::::::: <br /> r <br /> ..: <br /> 15727 '—�-..:.. :...:....:...>.........::.;�:::::.....:;.::;.::.• <br /> 03/11191 ;61GBIECT:::.;::::::;.;:.::;::::;::,:.. <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNA-WRE <br /> m Elaine Lavine (415)-571-2482 !4 <br /> o REPRESENTING [:K]aME;'OPERATOR =REGIONAL BOARD COMPANY OR AGENCY NAME <br /> pLOCALAGENCY [ OTHIEq ARCO Products Company <br /> O <br /> ADDRESS P.O.Box 5811 San Mateo CA 94402 <br /> STREET CITY STATE ZIP <br /> NAME OONTACTPERSON PHONE <br /> Z Q ARCO Products Company [:]UNKNOWN Elaine J.Lavine (415)-571-2482 <br /> O a ADDRESS San Mateo CA 94402 <br /> 8s PO BOX 5811 ATTN: Env.Compl.Dept <br /> STREET CITY STATE ZIP <br /> FACILITY NAME OF APPLICABLE) OPERATOR PHONE <br /> zARCO FACILITY 02076 I L J S ENTERPRISE INC (209)-334-3678 <br /> 0 <br /> U ADDRESS 800 EAST KETTLEMAN LA LODI SAN JOAQUIN 95240 <br /> STREET CITY COUNTY ZIP <br /> LL, <br /> CROSS STREET <br /> HWY 99/E KETT'LEMAN LN <br /> rt , <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> cn <br /> z_ SAN JOAQUIN COUNTY PUBLIC HEALTH DOUG WILS&� R �} ^� e�(209)-468-3420 <br /> z REGIONAL-BOARD l U�f AA FN f�1L I �� I h ONE <br /> �_ CENTRAL VALLEY REGION LEE BOGQ � �) - 0916}-361-5600 <br /> (�) NAME QUANTITY LOST(GALLONS) <br /> UGASOLINE =UNKNOWN <br /> p (� QUANTITY LOST(GALLONS) <br /> UNKNOWN <br /> DATE DISCOVERED(MM-0D-YY) HOWDISCOVERED p►.n/ENTORY CONTROL =SUBSURFACE MONITORING =NUISANCE CONDITIONS <br /> 03/02/1991 TANK TEST pTANKREMOVAL MOTHER DRIVE OFF <br /> �w <br /> > DATE DISCHARGE BEGAN(MM-0D-YY) METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> 0 w 03/02J1991 CaINKNO'AN 0 MOVE CONTENTS p REPLACE TANK =CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED? p REPAIR TANK = REPAIR PIPING =CHANGE PROCEDURE <br /> [j]YES =NO IF YES,DATE 03/02/1991 Q OTHER SHUT OFF PUMPS <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> O¢(n =TANK LEAK p UNKNOWN = OVE,RF!LL =RLBTURE/FAILURE ❑SPILL <br /> �jU =PPNG LEAK 0 OTHER p CORROSION p UNKNOWN 0 OTHER DRIVE OFF <br /> w w CHECK ONE ONLY <br /> U M]UNDETERMINED p SOL ONLY =GROUNDWATER p DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY Uj <br /> p NO ACTION TAKEN p PRELMJARY SITE ASSESSMENT WORKPLAN SUBMITTED p POLLUTION CHARACTERIZATION <br /> Cc <br /> U p LEAKBEING CONFIRMED pELI PR4ARY SITE ASSESSMENT UNDERWAY 0 POSTCLEANUP MONITORING IN PROGRESS <br /> Cn p REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) p CLEANUP UNDERWAY <br /> CI-ECK APPROPRIATE ACTION(S) p EVACUATE AND DISPOSE(ED) =REMOVE FREE PRODUCT(FP) =ENHANCED BIO DEGRADATION(IT) <br /> EVACUATE AND TREAT(ET) p PUMP&TREAT GROUNDWATER(GT) =REPLACE SUPPLY(RS) <br /> 00 =CAP SITE(CD) pLU p <br /> U p CONTAINMENT BARRIER(CB) pX NO ACTION REQUIRED(NA) p TREATMENT AT HOOKUP(HU) =VENT SUPPLY(VS) <br /> p VACUUM EXTRACT(VE) =OTHER(OT) <br /> CUSTOMER DROVE OFF WITH NOZZLE IN CAR. FIRE DEPARTMENT RESPONDED. USED ABSORBENT TO <br /> 2 CLEAN UP. DISPOSED OF IN RUBBER CANS. SAN JOAQUIN COUNTY AND OES NOTIFIED. <br /> 2 <br /> O <br /> U <br />