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UAR/PROP 65
Environmental Health - Public
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PR0232261
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UAR/PROP 65
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Last modified
7/6/2020 4:43:41 PM
Creation date
11/6/2018 10:06:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
RECORD_ID
PR0232261
PE
2361
FACILITY_ID
FA0002590
FACILITY_NAME
THORNTON 76
STREET_NUMBER
8606
STREET_NAME
THORNTON
STREET_TYPE
RD
City
STOCKTON
Zip
95209
APN
07242019
CURRENT_STATUS
01
SITE_LOCATION
8606 THORNTON RD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\T\THORNTON\8606\PR0232261\UAR _ PROP 65 .PDF
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EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCALAGENCY'USE ONLY <br /> REPORT BEEN FILED 7 <br /> ❑ YES NO ❑ YES ❑ NO 1 HERBY CERTIFYTHAT I HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> REPORT DATEDI F UTIONHOWN ON THE STRUCT N HEET ON THE BACK P E OFTHIS FORM <br /> CASE x � {� r 1. <br /> r <br /> NE <br /> DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNA RE <br /> m <br /> w REPRESENTING _��OWNER/OPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME <br /> cc <br /> ❑ LOCAL AGENCY ❑ OTHERwS cC r �7\. ` E /' <br /> E ADDRESS 1 G n IV <br /> si <br /> J NAME CITY STATE ZIP <br /> CONTACTPERSON PHONE �7 <br /> W 1 O��_CS 1 ' \R�� Imo' `1J 1 ❑ UNKNOWN �yf����l <br /> d a ADDRESS A , n �+ c, <br /> ��� _ S.:Y ,'tom- ail.6 s� a��PNv�v•'v ` gNLu <br /> STREET CITY STATE <br /> P <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> ��� c��,i�`1 r C. ,���� K S carte 'INc- (49 ) yeas—3ki <br /> ADDRESS <br /> CITY <br /> CROSS STREET REQ couraTY ZIP <br /> A�� S <br /> O LOCAL AGENCY AGENCY NAME CONTACT PERSON <br /> z co PHONE <br /> w� S �O� veru17 L,N <br /> w uj REGIONAL BOARD PHONE <br /> as <br /> cl) <br /> w (1) NAME QUANTITY LOST(GALLONS) <br /> 0 <br /> aA S<��. 1 (al L 4 l= \��L LLQ•Vim- ` T)oz_L C_411\1 az UNKNOWN <br /> m z (Z) <br /> ❑ UNKNOWN <br /> Z DATE DISCOVERED A Q NOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> m ©MI a M 1 D 1 DI 1 Y t, Y ❑ TANK TEST ❑ TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> W M M D D Y r UNKNOWN ❑REMOVE CONTENTS ❑CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> p HAS DISCHARGE BEEN STOPPED 7 ❑REPAIR TANK —]CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> o I�iI YES ❑ NO IF YES,DATE M) ` D , ol 9Y a Y ❑REPLACE TANK ❑ OTHER <br /> SOURCE OF DISCHARGE r-�/ CAUSE(S) <br /> a ❑ TANK LEAK ISI UNKNOWN ❑ OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> �O ❑ PIPING LEAK F_- OTHER ❑ CORROSION UNKNOWN ❑ OTHER <br /> N wa CHECK ONE ONLY <br /> U UNDETERMINED ❑ SOIL ONLY ❑ GROUNDWATER ❑ DRINKING 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 /> w <br /> ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS <br /> U <br /> ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ' CLEANUP UNDERWAY <br /> aCHECK APPROPRIATE CR <br /> OFM-TA";ACTION(S) <br /> � EXCAVATE&DISPOSE(ED) E:] REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> p p ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> a ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ❑ VACUUM EXTRACT(VE) ❑ OTHER(OT) <br /> U) <br /> z <br /> z <br /> w <br /> 0 <br /> O <br /> U <br /> HSC 05(MO) <br />
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