Laserfiche WebLink
UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES ORLOCALAGENCY USE ONLY <br /> REPORT BEEN FILED? YES ® NO }MEREBY CEtiT1FY T13AT F ANF A.aESIf�1A? Q GQVEANMfNf EMPLOYE 11N4THA?<E HA1fl: <br /> ❑ YES NO ❑ fiEPORTED FHFS IFIFORMA?iDN?0 LS?CAk fi)fF(CIALS PEJRSUANT?0G?[a1�F 25tbd7 nF <br /> REPORT DATE <br /> CASE p ?HE HEAL[F AND SAFtY CODE <br /> SIGNED <br /> FAN <br /> 3D 9 Y OY SIGNATU <br /> IVIDUAL FILING REPORT PHONE 1-800-01— <br /> DANIEL <br /> $OO 451 �f <br /> T. KIRK ( )2799-134 <br /> co NG ® OWNERlOPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME <br /> ALAGENCY OTHER SHELL OIL COMPANY <br /> 90 WILLOW PASS ROAD STE. 900 CONCORD Cs. ZAP <br /> PHONEONTACTPERSON 1-800-451— <br /> Ln SHELL OIL COMPANY ❑ UNKNOWN DIANE LUNDQUIST ( )2799-127 <br /> N cc <br /> 2� <br /> R a ADDRESS <br /> w SAME AS ABOVE OR P.O. BOX 4023 CONAORD <br /> OPERATOR PHONE <br /> FADDRESS <br /> E(IF APPLICABLE) ROBERT LUTZ <br /> STATION (209 ) 943-1311 <br /> . EL DORADO ST66TREET ,OCKTON SAI� �AQUIN �P <br /> Fn CROSS STREET <br /> TYPE OF AREA ®COMMERCIAL❑INDUSTRIAL❑RURAL TYPE OF BUSINESS ® RETAIL FUEL STATION <br /> ADAMS ST• ❑RESIDENTIAL ❑OTHER ❑ <br /> FARM OTHER <br /> r <br /> AGENCY <br /> AGENCY NAME CONTACTPERSON PHONE <br /> JOAQUIN CO. ENVIROMENTAL HEALTH KASEY FOLEY ( 209) 468-3420 <br /> PHONE <br /> AL BOARD <br /> TRAL VALLEY QUANTITY LOST(GALLONS) <br /> NAME ® UNKNOWN <br /> PECT WEATHERED GASOLINE <br /> UNKNOWN <br /> ISCOVERED HOWDISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING CJ NUISANCE CONDITIONS <br /> 4M 0 D 5D 9 Y O Y ❑ TANK TEST �❑ TANK REMOVAL OTHER SOIL BORING <br /> DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> ❑ UNKNOWN ❑ REMOVE CONTENTS ❑ REPLACE TANK ❑ CLOSE TANK <br /> W M M D D Y Y <br /> l Dp HAS DISCHARGE BEEN STOPPED? ❑ REPAIR TANK ❑ REPAIR PIPING CHANGE PROCEDURE <br /> c� ❑ YES ❑ NO IFYES,DATE M M D D Y v ❑ OTHER <br /> w SOURCE OF DISCHARGE TANKS ONLY/CAPACITY MATERIAL <br /> CAUSES) <br /> �D ❑ TANK LEAK UNKNOWN 7—R M 1—]..OM GAL• ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE <br /> ❑ PIPING LEAK AGE 7 YRS STEEL ❑ CORROSION UNKNOWN <br /> ❑ OTHER <br /> UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br /> w w CHECK ONE ONLY <br /> C ❑ UNDETERMINED ® SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Q cn ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> V ❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS E::] NO FUNDS AVAILABLE TO PROCEED ® EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> z E] CAP SITE(CD) EJEXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> w ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> NO ACTION REQUIRED(NA) ® OTHER(oT) TO BE DETERMINED <br /> °C <br /> ❑ TREATMENT AT HOOKUP(HU) ❑ <br /> PERMITTING IN PROGRESS TO REPLACE TANKS. NEW TANKS WILL BE PLACED INALTERNATE <br /> w LOCATION. <br /> HS005(4l87) <br />