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Amk <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) 1 CONTAMINATION SITE REPORT <br /> :::>:::..;>: .. <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES ` : ... ;: . <br /> FEPORTBEEN FILED? Jt1 LIi4: : 1 'I iRL Sr A4 ll., 1 7VlC?t i ::1 E7::Omt.l::1 <br /> Q YES <br /> NO Qp = ro s # p # srw.r¢s>x tai <br /> REPORT DATE(MM-0D-YY) CASE# 7'y <br /> :::;:;.. <br /> 03/11/91 15727 - ... <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNAjl.IRE <br /> m Elaine Lavine (415)-571-2482 <br /> ow REPRESENTING _10WN OPERATOR =REGIONAL BOARD COMPANY OR AGENCY NAME <br /> =LOCAL AGENCY QOTHEq ARCO Products Company <br /> Ir O <br /> ADDRESS P.O.Box 5811 San Mateo CA 94402 <br /> STREET CITY STATE ZIP <br /> NAME CONTACTPERSON PHONE <br /> Z Q ARCO Products Company =LNKND Elaine J.Lavine (415)-571-2482 <br /> San Mateo CA 94402 <br /> 8s a ADDRESS PO BOX 5811 ATTN: Env.Compl.Dept. <br /> STREET CITY STATE ZIP <br /> FACILITY NAME OF APPLICABLE) OPERATOR PHONE <br /> o ARCO FACILITY 02076 L J S ENTERPRISE INC 209 -334-3678 <br /> ADDRESS 800 EAST KETTLEMAN LA LODI SAN JOAQUIN 95240 <br /> 0STREET CITY COUNTY ZIP <br /> w <br /> CROSS STREET <br /> HWY 99/E KETTLEMAN LN <br /> Z LOCAL AGENCY AGENCY NAME CONTACT PERSON ,rz,, PHONE <br /> Zuj <br /> _ SAN JOAQUIN COUNTY PUBLIC HEALTH DOUG WILSN- .� , (209)-468 3420 <br /> Z /! f� PHONE <br /> uJ. REGIONAL BOARD <br /> IIA <br /> CENTRAL VALLEY REGION LEE BOGOQ _ l sn (916)-361-5600 <br /> (�) NAME — r / QUANTITY LOST(GALLONS) <br /> GASOLINE ���IT/ l�L r� Q UNKNOWN <br /> cn?p? LOST(GALLONS) <br /> m Z =UNKNOWN <br /> DATE DISCOVERED(MM-0D-YY) HOWDISCOVERED =INVENTORY CONTROL =SUBSURFACE MONITORING =NUISANCE CONDITIONS <br /> 03/02/1991 TANK TEST =TANKREMOVAL =OTHER DRIVE OFF <br /> UjW <br /> �� DATE DISCHARGE BEGAN(MM-0D-YY) METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> LU 03/02/1991 =UNKNOWN 0 REMOVE CONTENTS Q REPLACE TANK =CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED? = REPAIR TANK = REPAIR PIPING =CHANGE PROCEDURE <br /> AYES =NO IF YES,DATE 03/02/1991 0 OTHER SHUT OFF PUMPS <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> v w =TANK LEAK UNKNOWN Q OVERFILL =RUPTUREJFAILURE =SPILL <br /> cn Q <br /> 9jU =PPNG LEAK 0 OTHER Q CORROSION Q UNKNOWN =x OTHER DRIVE OFF <br /> W w CI-ECK ONE ONLY <br /> =UNDETERMINED =SOL ONLY Q GROU NDWATER Q DRf3QJG WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Q NO ACT10N TAKEN Q PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED Q POLLUTION CHARACTERIZATION <br /> Cl <br /> Cl <br /> < Q LEAKBEING CONFIRMED = PRELIMINARY SITE ASSESSMENT UNDERWAY Q POSTCLEANUP MONITORING IN PROGRESS <br /> Q REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) Q CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) =EVACUATE AND DISPOSE(ED) Q REMOVE FREE PRODUCT(FP) =ENHANCED BIO DEGRADATION(IT) <br /> O p =CAP SITE(CD) Q EVACUATE AND TREAT(ET) Q PUMP&TREAT GROUNDWATER(GT) =REPLACE SUPPLY(RS) <br /> Q CONTAINMENT BARRIER(CB) pX NOACTION REQUIRED(NA) =TREATMENTAT HOOKUP(HU) =VENT SUPPLY(VS) <br /> =VACUUM EXTRACT(VE) Q OTHER(OT) <br /> CUSTOMER DROVE OFF WITH NOZZLE IN CAR. FIRE DEPARTMENT RESPONDED. USED ABSORBENT TO <br /> Uj <br /> CLEAN UP. DISPOSED OF IN RUBBER CANS. SAN JOAQUIN COUNTY AND OES NOTIFIED. <br /> 0 <br /> U <br />