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v \ <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE,It, <br /> (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br /> FOR LOCALAGENCY;USE ONLY <br /> YES NO Y REPORT BEEN FILED? 3}iEREBY BEATIFY THAT I AM A DE$IGNA�ED GOYiNMENT EMPLOYEE AND THAT;dHAVE <br /> Et © AEYC;F(TED:7HI5 fNFOPMATION TO LOCAL F.FICIALS PURSUANT TO SEGT)ON 25oba10F <br /> REPORT DATE cASEs THEHEALTHANDSAFTYODDE <br /> r c <br /> 0.19 Mj 0 8 D 8 yj 8 y SIBNFD i..: <br /> NAME OF INDIVIDUAL FILING REPORT <br /> J.'PHONE-'_ C - SiT�7'-< <br /> UREent fo� ARCO <br /> David L. Brown .�$ ' 98 j40� ' 984-6536REPRESENTING F-1 0 OWNERIOPERATOR O REGIONAL130ARD COMPANY OR AGENCY NAME <br /> p LOCAL AGENCY E OTHER <br /> a Pacific Environmental Group, -Inc. <br /> LU <br /> ADDRESS <br /> 1601 Civic Center Drive, Suite 202, Santa Clara, CA 95050 <br /> STREET CITY STATE ZIP <br /> LU NAME CONTACTPERSON PHONE <br /> ARCO petroleum Products UNKNOWN Mr. Kyle Christie (415) 571-2434 <br /> y <br /> a ADDRESS <br /> 2000 Alameda de las Pulgas, Suite 218, San Mateo, CA 94402 <br /> STREET CITY STATE - ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> z ARCO Station #760 David Hildenbrand (209) 368- 7863 <br /> a ADDRESS <br /> 225 So. ChAkee STREET Lodli San Joaquin 95240 <br /> y zip <br /> CROSS STREET TYPE OF AREA a COMMERCIAL[:D INDUSTRIAL E:]RURAL TYPE OF BUSINESS ® RETAIL FUEL STATION <br /> Lodi Avenue ©RESIDENTIAL a OTHER a FARM Q OTHER <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w6q an Joaquin Local Health District Lori Cotulla (209} 68-3420 <br /> w REGIONAL BOARD PHONE <br /> a <br /> Central Valley Lee Boggs (916) 361-5600 <br /> w (�) NAME QUANTITY LOST(GALLONS) <br /> Waste Oil F UNKNOWN <br /> 0 (2 <br /> N UNKNOWN <br /> w OATEDISCOVERED HOI1W��DISCOVERED 0 INVENTORY CONTROL SUBSURFACE MONITORING F NUISANCE CONDITIONS <br /> F 0 M 9 M i D D 8 v 8 y L___I TANK TEST ® TANK REMOVAL OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> 4 <br /> w M M D D y y 0 UNKNOWN F-1REMOVE CONTENTS a REPLACE TANK a CLOSE TANK <br /> p HAS DISCHARGE BEEN STOPPED T REPAIR TANK REPAIR PIPING CHANGE PROCEDURE <br /> c� a YES [:] NO IF YES,DATE M M D D yl r ® OTHER remove tank <br /> 0 <br /> w SOURCE OF DISCHARGE TANKS ONLYICAPACITY MATERIAL CAUSE(S) <br /> TANK LEAK a UNKNOWN GAL, 0 FIBERGLASS El <br /> OVERFILL O RUPTURE/FAILURE <br /> PIPING LEAK AGE YRS STEEL CORROSION UNKNOWN <br /> 2 O OTHER overfill O UNKNOWN OTHER SPILL D OTHER <br /> UJ w CHECK ONE ONLY <br /> a <br /> v O UNDETERMINED ® SOIL ONLY O GROUNDWATER DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> r CHECK ONE ONLY <br /> zN <br /> Q a O SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) XD CLEANUP IN PROGRESS a SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> v'n E-1 NO ACTION TAKEN O POST CLEANUP MONITORING IN PROGRESS NO FUNDS AVAILABLE TO PROCEED ® EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> z CAP SITE(CD) O EXCAVATE 8 DISPOSE(ED) a REMOVE FREE PRODUCT(FP) ENHANCED BIODEGRADATION(IT) <br /> Es0 <br /> F CONTAINMENT BARRIER(CB) EXCAVATE 8 TREAT(ET) a PUMP&TREAT GROUNDWATER(GT) O REPLACE SUPPLY(RS) <br /> cc TREATMENT AT HOOKUP(HU) NO ACTION REOUIRED(NA) OTHER(OT) <br /> F- <br /> C(Opy <br /> z <br /> HSC OS laleTl <br />