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ARCHIVED REPORTS_XR0003087
Environmental Health - Public
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EHD Program Facility Records by Street Name
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K
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KETTLEMAN
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248
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3500 - Local Oversight Program
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PR0545328
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ARCHIVED REPORTS_XR0003087
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Entry Properties
Last modified
2/11/2020 9:02:06 PM
Creation date
2/11/2020 11:05:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003087
RECORD_ID
PR0545328
PE
3528
FACILITY_ID
FA0009569
FACILITY_NAME
Custom Design Manufacturing
STREET_NUMBER
248
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
Ln
City
Lodi
Zip
95240
APN
06206046
CURRENT_STATUS
02
SITE_LOCATION
248 E Kettleman Ln
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)1 CONTAMINATION SITE REPORT <br /> HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY `E A D Tu!,T ;HAVE <br /> ,G <br /> VERU=hCY I HEREBY CERTIFY THAT i Ates A DESIGNATED G^L`FT E!'>LOr' <br /> SES rt� N'j REPORT BEEN FILED (�YES O NO REPORTED THIS INFORMATION TO LOCAL OFFICIALS PURSUANT TO SECTION 25180 7 OF �.+. <br /> THE HEALTHAND SAFTYCODE 1 <br /> CASE• 1.t� (U �i /�[ l <br /> ' PORTs � .! DATE <br /> SIGHE <br /> �" {• 4I PHONE SIGNATURE t <br /> •1. 'c Ct JN[)k C)JAL=IL,PJG RF PO RT i 1 -�_ - - -- --- <br /> ( f <br /> tAECIt NAL ROARP I CO�.MPANY OR AGENCY NAM <br /> I � prPF,_GENT'\G ,^,vPub�RK)PFRA'OP J 1 - <br /> 1 <br /> AS51,ESI <br /> 4 i I � J S-d7E ZIP <br /> cm <br /> STP E E7 PHONE <br /> � i Cr)NTACTPERSON _ '�e � <br /> �I NAME _ I 1 � � o r�11 - ( , <br /> �f <br /> UNKNOWN ` I�� I' �i L C[.+�-3U ��� S \ r ) — —.�.-- <br /> ' �I ADD f$S STATE ZIP <br /> w I ( L F / ` CRY <br /> STPE ET <br /> I OPERATOR PHONE <br /> I FACILITY NAME I F APPLICABLE) r <br /> ( YL ► c <br /> I c <br /> € ° ADDRESS <br /> — Jr ( , )1 . <br /> L rl E I �I-� f - 41, <br /> STCOV HTV —ZIP <br /> ~ REET Cm <br /> w u <br /> CAOSSSTREET— 7 <br /> I L'k AL AGj"C" AGENCY NAME <br /> CONTACTPERSON I P,-IOtiE <br /> L k L <br /> —�" f <br /> Z rr }} <br /> REC')t I IOARD <br /> s ` � r 4 <br /> leili.-- — ` — 71 iY I C3S=�c, —� <br /> N Zt'E <br /> .- '--0111 <br /> I i HOW QISCOVERED INVENTORY CONTROL BSURFACE MONITORING I_j NU ISA.CE GJhQI I'D S <br /> DATE OISCOVEPEI) <br /> i I / 71 L1 TANK TEST TANK REMOVALpTHEA it/C - <br /> w <br /> METHOQ US D TO STOP DISCHARGE(CHECK ALL THAT PL`) / <br /> DATE DISCHARGE BEGAN REPLACE TANK !-i'/CLOSE TANK <br /> I € UNKNOWN <br /> REMOVE CONTENTS L-J <br /> ' �L- �I-D- D Y Y, _-_ ❑ ED REPAIR PIPING 1 CHA.GF PROCEDU9E <br /> I � REPAIR TANK <br /> I HAS DISCHARGE 9 EN STOPPED i J , r <br /> N� C$4ECK <br /> OTHERNO IF YES DATE YES u p pjE OF DISCHARGE ' CAUSES)� OVERFILL RUPTUREIFAILURE SPILL <br /> TANKLEAK r^ UNKNOWN CORROSION UNKNOWNOTHERPIPING LEAK U OTHER D <br /> ONEOtiLY GROUNDWATERDRINKSNGWATER (CHECK ONLY>F YlATER WELLS HAVE ACTUALLY 5ERd AFFECTEC)')NOETERMINED �SCILONLY EDK ONE ONLY POLLUTIONCHARACTERIZATION NO ACTION TAKEN � r PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED POSTCLEANUPMO ITORWG VPROGRESSLEAKBEINGCONFIRI,FDID <br /> PRELIMINARY S€TE ASSESSMENT UNDERWAYCASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UNDCFYfAY <br /> REMEDIAT O'1 PLAY -; ❑ REMOVE FREE PRODUCT(FP) ENHANCED 8b DEGRADATION(IT1CK APPROPRIATE ACTIONISI EXCAVATE S DISPOSE(EU) <br /> e c rcxc.I-•+ �- I r UUP E TREAT GROUNDWATER(GT) REPLACE SUPPLY IRS) <br /> �Z EXCAVATE b TREAT(ET) <br /> C v'SITE(I-DI VE VT SOIL{VS) <br /> u � n NO ACTION REQUIRED(!SA) TREATMENT AT HOOKUP(HU) <br /> „ x GONTAINM;:NT BAfl�iw 4C', <br /> I _ <br /> J41 E%'RAC7 OTHE R(O� S�T f LLI <br /> CL' h'] --- <br /> /4 (LLL/ LL/ <br /> MBCOSIttp611x^p <br />
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