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UAR/PROP 65_PRE 2019
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0501569
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
4/3/2020 2:41:36 PM
Creation date
11/7/2018 9:42:03 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0501569
PE
2381
FACILITY_ID
FA0005149
FACILITY_NAME
GENERAL POTATO & ONION DIST
STREET_NUMBER
1515
Direction
W
STREET_NAME
WEBER
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
1515 W WEBER AVE
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
KBlackwell
Supplemental fields
FilePath
\MIGRATIONS\W\WEBER\1515\PR0501569\UAR_PROP 65.PDF
Tags
EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) /CONTAMINATION SITE REPORT <br /> EMERGENCY / HAS STATE OFFICE OF EMERGENCY SERVICE FOR LOCAL AGENCY USE ONLY <br /> ❑YES REPORT BEEN FILED I HEREBY CERTIFY THAT I AM A.DESIGNATED GOVERNMENT.EMPLOYEE AND THAT T HAVE <br /> LLLYIYIYI ❑YES .REPORTED THIS::INFORMATION.TO LOCAL:OFFICIALS PURSUANT TO SECTION 25780.7 OF <br /> REPORT DATE CA IHEH AN __ Ern, <br /> l a3 r <br /> M M 0 V Y SIGNED DATE <br /> NAME INDIVIDUAL FILING REPORT PHONE SIGNATUR <br /> R REPRESENT OWNEMDPERATOR ❑ REGIONALBOARD CO ORAG/ENCYNAME <br /> LOCAL AGENCY ❑ OTHER /. 0 194 o)r ��.� <br /> ¢ ADDRESS �/ lll/// <br /> Ale- <br /> 8l ATE N <br /> NAME y��" CONTACTPERSON PHON�E-{ r/ <br /> iTi /i ❑ UNKNOWN (/�✓ cv�j /9�7-y(/O/� <br /> r�a ADDRESS <br /> moi M/ssi®� <S017-E 2.5� <br /> Cm STATE nv <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> � (205) -el(o <br /> ADDRESS <br /> ISIS 6J.cue% S �✓ Asa $3 <br /> 9TpEEf CIIY CWMfV P <br /> CROgSSSTTREET TYPE OF AREA ❑COMMERCIAL INDUSTRIAL ❑RURAL TYPEOFBUSINESS ❑ RETAIL FUEL STATION <br /> VA-b45&�� s ❑RESIDENTIAL ❑OTHER ❑ FARM OTHER <br /> g LOCALAGENCV AGENCY NAME CONTACTPERSON PHONE <br /> N <br /> �22 ( 209) �&,� <br /> wR GIONALBOARD <br /> PHONE <br /> yq (7) NAME QUANTITY LOST(GALLO <br /> 5 UNKNOWN <br /> (2) <br /> y ❑ UNKNOWN <br /> M <br /> DATEDISCOVERED <br /> LL'D GY Y HD❑�NRED OINVENTANKTORYCONTROL a SUBSURFACE MONITORING ❑ NUISANCECONDITIONS <br /> /M /MREo <br /> DATE DISCHARGE BEGAN F��Jj/,, METH SED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> w M M C D v r �I "',� I.J MOVE CONTENTS ❑ REPLACE TANK ❑ CLOSETANK <br /> I HAS DISC GE BEEN STOPPED p ❑yREPAIRTA/N� , -REEPPAIR,PIPING <br /> � ❑ CHANGE PROCEDURE <br /> ❑ VES ❑ NO IFYES.DATE M / M / o o 9 v 0 Y u OTHER <br /> SOURCE OF DISCHARGE TANKS ONLY/CAPACITV MATERIAL CAUSE(S) <br /> F-1TANKLEAK UNKNOWN GAL. ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTUREIFAILURE <br /> ¢ ❑ PIPINGLEAK AGE YRS STEEL ❑ CORROSION �)�NKNOWN <br /> ❑ OTHER Q UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br /> ywyw CHECKONEONLY <br /> t3� ❑ UNDETERMINED 0 SOILONLY GROUNDWATER ❑ DRINKINGWATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECKONEONLY <br /> w <br /> ¢a ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP INPROGRESS ❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> uy ❑ NOACTIONTAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> o� ❑ CAP SITE(CD) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREATGROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> ❑ TREATMENT AT HOOKUP(HU) a NO ACTION REQUIRED INA) ❑ OTHER(OT) <br /> y F�rwwrl CJ/[-L- BGs e&4(jeen 7D E rf/E NRTu A-r✓0 <br /> TSN r ®F 0clu7T`}71!<A>/`-uo rU 195 3v 7WE- <br /> N9Co5NaT) <br />
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