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0 9 <br /> UNDERGROUND STOMIDE TANK UMUTHORM RELEASE(LEAK)I CONTMINATION SITE REPORT <br /> EMERGENCY STATE OFFICE OF EMERGENCY SERIES <br /> YES I@ No REPORT BEEN FILED? 0YES ONO <br /> CASE# <br /> WSMICOUNTYOff: , <br /> 1 0 Y ...� .� H <br /> NAME OF INDIVIDUAL FILING REPORTPH E � <br /> Cheryl Allen 21 -1917ZZ <br /> �� r <br /> REPRESENTING N OWNEFRVOPERATOR REGIONAL BOARD I COWANY OR AGENCY NAME iA <br /> ❑LOCALAG CY OTHER SSC <br /> ADDRESS <br /> 308 S Akard St, Three SSC Plaza Room o.: 900 Dallas 5202-5399 <br /> STREET CITY NATE ZIP <br /> NAME CONTACT PERSON P E <br /> A be UNKNOWN <br /> ADDRESS <br /> v cmc STATS ZIP <br /> FACILITY NAME(IF ABLE) OPERATOR ONE <br /> SBC SKTNCA11 (t.lP0 6) Facility I As above As above <br /> ADDRESS <br /> 907 LINCOLN RD STOCKTON San Joaquin 92507 <br /> $MET CITY COUNTY ZIP <br /> CR STREET PACIFIC <br /> I <br /> LOCALAGENCY AGENCY AmE CrT'T PHONE <br /> Z San Joaquin County CATAN�'A � t�9 3-3419 <br /> 9 -43-333 <br /> REGIOIALII CV-Regional PHONE <br /> Water Quality Control Board <br /> Jim rr h (916)4154-3291 <br /> ($) NAME QUANTITY LOST((GALLONS) <br /> LST contains Diesel APX 40UNKNOWN <br /> ac1fity called the Bout fire department to ass ist <br /> UNKNOWN <br /> 7's�� ISIr Haji DISCOVERED <br /> a INVENTORY CO SUBSURFACEMONITORING NG NUISANCE CONDITIONS <br /> m ° ° Qx 5 ` TA TEST TANK a cT R®RIVFR OBSERVATIONS <br /> TE DISCHARGE BEGAN MET140D USED TO STOP DISCHARGE ECKALL TAPPLY) <br /> 0 5 1 2 0 5 REMOVE CONTENTS REPLACE TANK CLOSETANK <br /> 1---LL—LUa—uNKNowN <br /> KA DISCHARGE SEEN STOPPED? PAIR TANK REPAIR PIPING CHANGE PROCEDURE <br /> 91 YES El NO IFYES,DATE 9 5 1 2 0 5 OTHER SPILL RESPONSE <br /> SOURCEDISCHARGE CAU S) <br /> TANK L [3 UNK NOVERFILL El RUPTUREIFAILLIRE SPILL <br /> PIPING OTHER CORROSION UNKNOWN OTIIER <br /> CHECK ONE ONLY <br /> UNDETERMINED ONLY GRCTLINr WA DRINKING A -;OH Ko YIFY&A Tar Y CIES) <br /> CHECK ONE ONLY, <br /> NOACTIONTAKEN El PRELIMINARY srreAssmmENT woRKPLAN SUBMITTED POLLUTION CHARACTERIZATION <br /> C]LEAK BEING CONFIRIAED <br /> ]PRELIMINARY SITEASSESSMENT UNDERWAY POSTCLEANUP MONITORING IN PROGRESS <br /> REMEDIATION PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) CLEANUP UE AY <br /> SCHE K TEACT S) VATE g 0 IS SE(ED) <br /> I� MOVE FREE PRODUCT(FP) ENH <br /> ANCED DEGRADATIONSUPPLY <br /> SITE{CU) EXCAVATE I T(F-T) _^ PUMP&TREAT GROUND WATER(GT)C ASRBARRIER(CS) NOACTT REQUIRED{ ) TR TME AT HOOKUP(HU) VENT <br /> Nothing in this form should be construed as a waiver, relinquishment or election of rights,remedies by SSC <br /> r or that SBC is refusing to comply with any federal, state and/or local regulations regarding reporting and/or <br /> cleanup. SBC expressly reserves all rights and remedies under all applicable federal and state lags. <br />