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' ,� X0021402 <br /> E:R <br /> ERGROUND STORAGE TANK UNAUTHORIZED RELRPnRTEASE(LEAK)I coNTAM[NATTON srrE ' <br /> -BiMROOYHAS STATE OFFICE OF EMERGENCY80MCEs 'FORL Ai. Y use UNI_Y.. No REPORT BEEN FILED? ®Yea ❑No r HEREBY GERTiFY THAT I AM ADEMM-rEo GOVErNM$Nr EMPLOYEE AND THAT I HAVE <br /> WORUM THIN MWOnMATION TO LOCAL OFFIOMa ouRSU kT 70 SECTION UIOA7 of <br /> 11/19/2012THE HSALTM aWn s3`►I�1Y cAoiz <br /> Cel EMA#12.6997 <br /> NAME OF INDMDIJAL FIUN(i REP41 <br /> ORT <br /> D.Chris Weber I (310)371.-x492 I �lv l ;. Ae <br /> IiEPR68EN�Nd <br /> L � � :❑LOCAL AGENCY ❑REQIONAL EtOARo COMPANY OR AGGY NAME <br /> ®OWNERIOPERATOR ❑OTHER BP Fest Coast Pxodueta LLC <br /> DREss ' <br /> P.O.Box 6038 Artesia i <br /> rlr�r CA 90702 <br /> "AME �r P++Ne . <br /> BP'West Coast Products LLC ❑unknown,Chris Weber 310 37.1-1492 <br /> AODRM { <br /> P.O.Box 6039 Artesia CA 90702 <br /> FOP Ft� � eTREET 8T <br /> FA O E <br /> ARCO#6080 LES BP West Coast Prodneta LLC 209 983-9144 <br /> ADDRESS <br /> 85 E Louise Ave Lathrop San Joaquin 95330 <br /> i BiAEET - <br /> $T <br /> ZIP <br /> I-S/Gouiae _ <br /> LOCALAGENCI' AGENCY NAME PRONE <br /> San•Joa uin County Environmental Health Dept, 09 46W420 <br /> REGIONAL SOAszn PMONE <br /> d Centra!Valley Regign(5) 1(916)464-3291 <br /> a (t? NAIN QUAWIM LOST(4ALLONS) <br /> Gasoline 87 Octane 0.5 Unkrimm <br /> ❑uhrtmowrh <br /> DATE DISCOVERED MOW DISCOVERED Tank TeMI Tank Removal NuimrwA commons <br /> 11/19/2012 IT=Control 3~&=iiQadhedh other <br /> DATE DISC <br /> MARGE B APPL <br /> 11/19/201x Renton conn is ❑Claw rank <br /> 171 UNKN <br /> OYVPJ Ll,lieRatrTenk ❑CBB[1psPromCura <br /> RAS OISCHARGE BEEN UMPFM <br /> �H Replace Tena ®Other-Absorbent <br /> s ®YES ❑NO IF Yes,DATE 11/19/2012 a�Pl <br /> jSOURCE OF DISCHARGE OEM <br /> ❑Takia Leak Q Piping Look ❑Unknown ®other ❑OVUM ❑Comoe10n Ej RupturerFneure 0 Unknown ❑Soil 0 Mar— <br /> Custornar Vehicle Cuatomars.Car hR the dapaneer <br /> CHECK ONE 014LY <br /> ®undetermined ❑Boll Only ❑Groundwater ❑Drinking Water—(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> i <br /> '❑No Action Taken ®®Cana Closed(Cloarrup CornploW or Unnowasary) <br /> .0 Look Being Confirmed ❑Poffution Chwactertration <br /> ❑Remedlatlon Plan g Pant Cleanup Mon]Wrq In Progress <br /> ❑Rrellmhaly 8149 A mmunant workplan Submitted p Cleanup underway <br /> D Prelhwirwry 814e Aesour ladt Undo <br /> CHECK APPROPMA ($ <br /> ❑Cap Site(Co) ❑Eumale&Treat(ET) ❑Tmotment At Hookup(Hu) ®Other <br /> [3rt <br /> C*Morn Ww Barrier(Ca) No Actlan Required(NA) Enhanced Blo Dagredatton(IT) <br /> D Vacuum Esrtrnct OM j Remove Free Product(FP) Replace Supply(R3) <br /> Ex=vat9 E Dlopme D Pump&Treat Oroundwatar bent sail 19 <br /> A customer drove In and hit dispenser N8 causing 0.5 gallons of 97 grade lUel to spill. The fire department did come <br /> out to check the dispenser to make sure there wag no environmental threat. The site contained the 0.5 gallon spiil with <br /> 5.1pounds of absorbent and disposed of the used absorbent io the hazardous waste drum onsite. <br /> VN-02B-In rvww.+�rhtdor,orE -- - Rev.IftGLn6 <br /> 5 <br /> Received Time Nov. 28. .2012 7: 30AM No- 1728 <br />