Laserfiche WebLink
CHEVRON USA 925 842 8370 11 /16 ' 98 16 : 41 N0 . 045 04 /07 <br />)I <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION- SITE REPORT -- - <br /> EMERGENCY HAS STATE OFFICE. OF EMERGENCYSEAVK:ES %FOR LOCA�'AGFNC .WoNLY <br /> REPORT SEEN FAEDY - <br /> ❑ YES NO ❑ YFD NO . AtPkSY CEFMFY, 7HAT.1 HAVt D15TR®UTEDTHISNFORMAYICNACCDRDINGTOYNE <br /> REPORT OATS OIS(R10UTICN'SNOWNO4 TME INSTRUCTION SHEET ON THERACK PAGE, OFTHR FORM <br /> CA E <br /> &ONm ;�; DATE <br /> NAME OF NDNOUAL FILWO REPORT <br /> FRONT SIGNATURE <br /> - der e. ff C . �/ ><e � I--I cels ► Y2_ J° <br /> REPRESENTMO OYNEROPERATOR I�J RFOIONALBOARO COO+MPANYOR AGENCY NAME <br /> I Ij LOCAL AGENCY ❑ OTHER {.. � � ✓ r0A gr0izilt i7Y <br /> a ADDRESS <br /> P. 0 . lox (o00y San Aoraor/, CA 94Pf83 �090A/ <br /> FREE aRy <br /> NAME CONTACT PERSON �APIIONE <br /> § z CAevevA FfIFAIV .1 C40P&4YpUNKN0WN Bree /1v ftp ( 92s) oylvvG95 <br /> 5 a ADDRESS <br /> p 0 • Rdx 600H sort CR 9yfB9 0901 <br /> s AK&T <br /> FI{CILITV NAME (IF APPLICABLE OPERATOR cm PHONE <br /> C/LevrO.t Service CWpan cAevrem 1641413 Co . ( J0q ) y :Fgf 9Y� <br /> ADDRESS AY <br /> oeo&D 4oWerS4craMcA+0 /2d• StocKtOn SanJva' oin gsalo <br /> Lu nRMkT GAY r�UMI. <br /> �i CRO&98TREET zw <br /> Ponce ,OuCrnn <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> San Joa vin CovA4y 1745 - EF}D 4Arl ( n Knoll 1'109 ) 46$ 3y <br /> REGIONAL BOARD PHONE <br /> Ccn �ral Vallt l2WQ Marr Lis (916 ) 2,SS304I <br /> g ' QUANTITYLOSTIGALLONSI <br /> § W UnitadteC Gat <br /> n <br /> sdl( Op NAME <br /> DNKNDWN <br /> al <br /> o UNKNOWN <br /> GATE DISCOVERED NOW DISCOVERED ❑ NVENTORYCONTROL ❑ SUBSURFACEMONITORING ED NUISANCF. CONDITIONS <br /> TANKTSST TANK REMOVAL OTHER s <br /> 4m DATE 0180HARGE BEGAN • r� METHOD User) TO STOP 015CNAROE (CHECK ALL THAT APPLY? <br /> NJ d 01 yj I UNKNOWN ❑ REMOVE CONTENTSXC .OSE TANK A REMOVE ❑ REPAIR PIPING <br /> HAS OW14ARM SEEN STOPPED 7 Y ❑ REPAIR TANK Q CLOSE TANK& FILL N PLACE Q CHANGE PROCEDURE <br /> YES El NO IFYES, DATE OMa Tj 3v EgAFPLACETANK ❑ OTHER <br /> SOURCE Of• DISGNAROE CAUSF.(Sl <br /> TANK LEAK UNKNOWN ❑ OVEPFAL ❑ RUPTUREFAILURE o SPILL <br /> Q PIPINGLEAK ❑ OTHER ❑ CORROSION UNKNOWN Q OTHER <br /> C 4MOKONEONI.Y <br /> UNDETERMINED SO0. 0NLY GROUNDWATER O DRINKING WATER . (CHEOK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECKONEON.Y <br /> @ Q NO ACTION TAKEN ❑ PRE?.WIM" SOFASSESSMENTYY01eMAN81jBMITTDD ❑ POLLUTIONCHARACTEHITATION <br /> q Q LEAK BENS CONRIRMED j<PRELMINARYSREASBESSMENTUNDF.RWAY O POSTCI.EAVuRMONRORNOINPROGRm <br /> REMMATNONPLAN ❑ CASE CLOSED (CLEANUP COMPLETEDOR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRMTEACTroN(S) 0 EXCAVATE & DISPOSE (ED) ❑ REMOVE FREE PRODUCT (FP) ❑ ENHANCED SIO DEGRAOItTKON (IT) <br /> nPPROPRIATEA <br /> ❑ CAPSTTELCD) a EXCAVATE TREAT In ❑ PUMP & TREAT GROUNDWATER (GT) o REPLACE SUPPLY (A&T <br /> w ❑ CONTNNMENTBARRIERICS) 0 NO ACTION REQUIRED INA) ❑ TREATMENTATHOOKUP (HU) ❑ VENTSOIL (VS) <br /> ❑ VMWMEXTRACT (VE) 6250THEA (OT) <br /> /villa / sifr assrss.arnf n<or ro.n/e/eFion . Furihrr a, /e assru.� c., f�. Ton. Fo�inq <br /> is uarranFtd . COrrtCrTYC ac6ow /D/qr!/{tos� b. / �y dfva/y to be /FPrfbr�yrdl <br /> once ezk� � of rsnl++n �-raf/on elrFlnt �/. <br /> MACATIP'1R <br />