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UNDERGROUND STORAGE TANr UNAUTHORIZED RELEASE (LEAK) I COr4TAMINATION SITE REPORT <br />EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br />„ REPORT BEEN FILED? <br />I YES [----- NO I YES NO I ill I <br />FOR LOCAL AGENCY USE ONLY <br />1 HEREBY CEFMFYTHAT I HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br />DISTRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM REPORTED BY I 33 CD rri DATE <br />44 2, 9 9,1 4 <br />CASE $ <br />SIGNED DATE <br />NAME OF INDIVIDUAL FILING REPORT <br />John Koch <br />PHONE <br />(510)675-6143 <br />SIGNAJJE <br />c---2F OWNER/OPERATOR 1 I REGIONAL BOARD REPRESENTING p <br />I I LOCAL AGENCY I I OTHER <br />COMPANY OR AGENCY NAME <br />Shell Oil Products Company <br />ADDRESS <br />P. 0. Box 4023 Concord California 94524 STREET ury STATE ZIP RESPONSIBLE PAR Y NAME <br />Shell Oil Products Co <br />UNKNOWN 1 I <br />CONTACT PERSON <br />Jeff Granberry <br />PHONE <br />(510)675-6168 <br />ADDRESS <br />P. O. Box 4023 STREET Concord CITY Californi a STATE (4452 Il. ZIP ISITE LOCATION FACILITY NAME (IF APPLICABLE) <br />Shell Service Station <br />OPERATOR <br />H. Wakabayshi <br />PHONE <br />P09)941-8743 <br />ADDRESS <br />2494 E. Fremont Stockton San Joaquin 95205 STREET my cowry vp cRqs5 STREET <br />Filbert IIMPLEMENTING AGENCIES LOCAL AGENCY AGENCY NAME <br />San Joaquin County PHS <br />CONTACT PERSON <br />Linda Turkelte <br />PHONE <br />(209)468-3441 <br />REGIONAL BOARD <br />Central Valley <br />PHONE <br />(916)286-1255 ISUBSTANCES INVOLVED NAME QUANTITY LOST (GALLONS) Gasoline <br />[9 UNKNOWN <br /> <br />I I UNKNOWN I CASE I SOURCE/ I DISCOVERY/ABATEMENT TYPE CAUSE DATE DISCOVERED <br />(11 41 4 i <br />HOW DISCOVERED [ I INVENTORY CONTROL SUBSURFACE MONITORING r I NUISANCE CONDITIONS <br /> TANK TEST iEil TANK REMOVAL I 1 OTHER <br />DATE DISCHARGE BEGAN <br />NI mi Di Di YI Y <br />METHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) <br />I I REMOVE CONTENTS I I CLOSE TANK & REMOVE 1 I REPAIR PIPING <br />I I REPAIR TANK [ I CLOSE TANK & FILL IN PLACE I I CHANGE PROCEDURE <br />g3REPLACE TANK I I OTHER <br />[X7 UNKNOWN <br />HAS DISCHARGE BEEN STOPPED? <br />F57 YES I I NO IF YES, DATE 0 .1 4 MI 2 D 2 DI 9 y 6 y <br />SOURCE OF DISCHARGE <br />I I TANK LEAK rx---f- UNKNOWN <br />I 1 PIPING LEAK I I OTHER <br />CAUSE(S) <br />I I OVERFILL I RUPTURE/FAILURE I I SPILL <br />I I CORROSION i-- UNKNOWN I 1 OTHER <br />CHECK ONE ONLY <br />[7 UNDETERMINED I I SOIL ONLY GROUNDWATER I I DRINKING WATER - (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) I CURRENT STATUS CHECK ONE ONLY <br />I I NO ACTION TAKEN I 1 PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED I I POLLUTION CHARACTERIZATION <br />I 1 LEAK BEING CONFIRMED 1-7 PRELIMINARY SITE ASSESSMENT UNDERWAY I I POST CLEANUP MONITORING IN PROGRESS <br />I I REMEDIATION PLAN I I CASE CLOSED (CLEANUP COMPLETED OR UNNECESSARY) I I CLEANUP UNDERWAY REMEDIAL ACTION CHECK APPROPRIATE ACTION(S) I I EXCAVATE & DISPOSE (E0) I I REMOVE FREE PRODUCT (FP) I I ENHANCED BID DEGRADATION (IT) (SEE BACK FCII DETAILS) <br />I 1 CAP SITE (CD) I I EXCAVATE E. TREAT (El) I I PUMP & TREAT GROUNDWATER (GT) I I REPLACE SUPPLY (RS) <br /> I CONTAINMENT BARRIER (CB) Li NO ACTION REQUIRED (NA) I 1 TREATMENT AT HOOKUP (HU) I I VENT SOIL (VS) <br />I 1 VACUUM EXTRACT (VE) un-im(ODcontaminated soil removed during tank replace' COMMENTS Soil samples collected during product tank and line replacement identifi, <br />TPh-G and BTEX in soils. <br />HSC 05)8/901