UAR/PROP 65_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY YES ® NO YES -� NO REPORT BEEN FILED 7 1 HEREBY CERTIFY THAT I HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE * DI STRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM REPORT DATE CASE s O M 3M 2 { 9 3 r SIGNED DATE NAME OF INDIVIDUAL FILING REPORT PHONE SIGNA RE Karen D. Clark � (510) 675-6114 I ca G� ow REPRESENTING � OWNER/OPERATOR F—] REGIONAL BOARD COMPANY OR AGENCY NAM I- cc R ❑ LOCAL AGENCY ❑ OTHER SHELL OIL COMPANY W ADDRESS 1390 WILLOW PASS RAOp,,SUTE 900 CTYCONCORD STATE CA z,P9452 W NAME CONTACT PERSON PHONE J z SHELL OIL COMPANY ❑ UNKNOWN JEFF GRANBERRY ( 510 ) 675-6145 o Q < ADDRESS Uj a 1390 WILLOW PASS ROAD, SUTE 900 STREET CITY STATE ZIP FACILITY NAME(IF APPLICABLE) OPERATOR k$yx3t Lynn Carroll PHONE o x3rxl (209 ) 957-5398 a ADDRESS o SAN JOAQUIN 9521 y 7700 MORELAND COURT STREET CITY STOCKTON COUNTY ZIP CROSS STREET N HAMMER LANE 0 LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE z Uj (209 ) 468-0333 Ic) SAN JOA UIN CO. ENV. HLH DIV w w REGIONAL BOARD PHONE J CENTRAL VALLEY REGION W.R.C.B. E. THAYER (916 ) 361-5600 co (1) NAME QUANTITY LOST(GALLONS) LU GASOLINE 2.9 GALS ❑ UNKNOWN Cw o (z) U ❑ UNKNOWN (1 z DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS Lu w 0 MI 3 MI 2 DI 6 DI 9 rI 3j ❑ TANK TEST ❑ TANK REMOVAL �X OTHER CUSTOMER DRIVE-OFF a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) n M M 2 D 6 D 9 r 3 r ❑ UNKNOWN ❑REMOVE CONTENTS ❑CLOSE TANK&REMOVE ❑REPAIR PIPING p HAS DISCHARGE BEEN STOPPED 7 F—]REPAIR TANK ❑CLOSE TANK 8 FILL IN PLACE ❑CHANGE PROCEDURE U o YES ❑ NO IF YES,DATEQI 3AI 2 D D rI v ❑REPLACE TANK ® OTHER PUMP SHUT-OFF DUF. To SOURCE OF DISCHARGE CAUSE(S) CUSTOMERV OFF a ❑ TANK LEAK F7 UNKNOWN F—] OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL O U)O ❑ PIPING LEAK )M:] OTHER ❑ CORROSION ❑ UNKNOWN OTHER Ly w CHECK ONE ONLY v UNDETERMINED ❑ SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) CHECK ONE ONLY z ❑ NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION w Q c ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS O ❑ REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED � J� ❑ CLEANUP UNDERWAY CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE 8 DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) JISEE OACK FO WTA� ) o ❑ CAP SITE(CD) ❑ EXCAVATE 8 TREAT(ET) ❑ PUMP 8 TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) w� w a F—] CONTAINMENTBARRIER(CB) E:] NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) ❑ VACUUM EXTRACT(VE) ® OTHER(OT) CLEANED WITH KITTY LITER AND GREASE SWEEP POWDER Z Customer drive off. Dispenser impact valve had to be replaced, 2.9 gallons of gasoline Uj released to concrete. The manager cleaned up spill with kitty liter and grease sweep Tt powder. Fire Dept was called and San Joaquin CoHnty Aenc nst�if*ed on 3/26/93. *OES notified on 3/29/93, but no report was required pir e an z. HSC 05(d90)