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�f <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICESFQ `QCALpGEtJGY U5E'ONLYX.X. <br /> REPORT BEEN FILED? <br /> ❑ YES NO ❑ YES NO 1 HE ![CERTlF?f: t! k QES1Clk7E0 GQVERNMFIFE EM�L07E ANQT}IkT 1i HAVE; <br /> M. Q ZtflS:INF TQ LOCA).QFFIC{AES P(3RS{lA) TO,S 251807 DF_, <br /> REPORT DATE CASE# 3HEH ANQCLQ <br /> F. <br /> IMI 1 7-4 8 ,1 8, ' <br /> NAME OF INDIVIDUAL FILING REPORT 7 <br /> PHONE NATURE <br /> Diane M. Hinson (209) 468-3441 <br /> REPRESENTING ❑ OW=RQ REGIONAL80ARD COMPANY OR AGENCYNAMELocALAGENGY ❑ OTHSan Joaquin Local Health District <br /> Cc ADDRESS <br /> 1601 ITREET E. Hazelton Avenue TyStockton �� CA 95205 <br /> 14 CONTACT CONTACT PERSON PHONE <br /> zit Continential Grain Company ❑ UNKNOWN Bob Lenhart 1603 ) 228-9222 <br /> CL ADDRESS <br /> LU <br /> 200 STREET Market Bldg-Suite 1050 �� Portland Oregon 97201 <br /> FACILITY NAME(IF APPLICABLE) ZIP <br /> OPERATOR PHONE <br /> Continential Grain Company same <br /> ADDRESS ( 209 466-1850 <br /> 1805 STREET R. Harbor Drive Stacktan San Joain 95203 ' <br /> F Gmr <br /> p) CROSS STREET TYPE OF AREA <br /> ❑COMMERCIAL� INDUSTRIAL❑RURAL TYPE OF BUSINESS ❑ RETAIL FUEL STATION <br /> Washi n ton ❑RESIDENTIAL ❑OTHER ❑ FARM ® OTHER <br /> 2 LOCALAGENCY AGENCY NAME CONTACT PERSON PHONE <br /> W San Joaquin Local Health District <br /> Diane M. Hinson ( 209)468-3441 <br /> w w REGIONAL BOARD <br /> R PHONE 1 <br /> Central Valley Sacramento A. Vorster $16 861-5670 <br /> m (:) NAME QUANTITY LOST(GALLONS) <br /> Q w Raxi a gasoline x© UNKNOWN <br /> g� {2) <br /> y- Diesel i <br /> UNKNOWN + <br /> LU z DATE DISCOVERED HOW DISCOVERED INVENTORY CONTROL SUBSURFACE MONITORING NUISANCE CONDITIONS <br /> ml Iml 2o 01 pY V ❑ TANK TEST TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> w M M o a Y ® UNKNOWN ❑ REMOVE CONTENTS ❑ REPLACE TANK ® CLOSE TANK <br /> pzn <br /> AS DISCHARGE BEEN STOPPED? <br /> �] p ❑ REPAIR TANK REPAIR P�PWG � CHANGE PROCEDURE <br /> p YES ❑ NO IFYES.DATE p MI 1 Mi 2 p 2 Q! $ Y g y ❑ OTHER - <br /> SOURCE OF DISCHARGE TANKS ONLWCAPACITY MATERIAL. CAUSE(S) <br /> ❑ TANK LEAK ® UNKNOWN GAL ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE <br /> ❑_PIPING LEAK AGE YRS ® STEEL ❑ CORROSION [B UNKNOWN <br /> ❑ OTHER UNKNOWN ❑ OTHER ❑ SPILLOTHER <br /> w CHECKONEONLY ❑ <br /> UFL: <br /> }� ❑ UNDETERMINED ❑ SOIL ONLY GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Q X pg SITE INVESTIGATION IN PROGRESS(DEFINNG EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> 0NO ACTION TAKEN <br /> ❑ ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> F3 ❑❑ CAP SITE(CO) EXCAVATE&DISPOSE <br /> LU <br /> ~ ) ❑ REMOVE � ❑ ENHANCED BIO DEGRADATON(IT) <br /> CONTAINMENT BARRIER(CB) ❑ ATE ❑ PAPb TREAT GROUNDWATER((T) <br /> ❑ REPLACE SUPPLY(AS) <br /> ❑ TREATMENTATHOOKUP(HU) ❑ NO ACTION REQUIRED(NA) ❑ OTHER(OT) <br /> w <br /> o� <br /> U <br /> HSG05lasn <br />