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Environmental Health - Public
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3500 - Local Oversight Program
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PR0545858
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
7/15/2020 6:34:56 PM
Creation date
7/15/2020 3:15:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545858
PE
3528
FACILITY_ID
FA0003600
FACILITY_NAME
Nella Oil #427
STREET_NUMBER
3300
STREET_NAME
WATERLOO
STREET_TYPE
Rd
City
Stockton
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
3300 Waterloo Rd
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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I <br />UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE <br />EMERGENCY <br />E::] YES NO <br />HAS STATE OFFICE OF EMERGENCY SERVICES <br />REPORT BEEN FILED ? <br />❑ YES �NO <br />FOR LOCALAGENCY;I <br />I HERE Y:CERTtFY:TKA <br />REPORTOATE ' <br />NAME <br />wt <br />CASE# <br />:.RE THIS INF <br />THEH ANO <br />- <br />AME OF IIIDIVID117 FILIN REPORT <br />SrjNED : <br />PHONE y <br />�� <br />— i� UNKNOWN <br />DATE DiSCOVERED How DISCOVERED ❑ INVENTORY CONTROL SUBSURIIFACEMONITORING ❑ NUISANCE CONDITIONS <br />)M <br />2 <br />p N y ❑ TANK TEST ❑ TANK REMOVAL ❑ OTHERI <br />REPRESENTING ❑ OWNERIOPERATOR E::]REGIONAL BOARD COMPANY OA AGENCYIN <br />LOCAL <br />O <br />AGENCY <br />L <br />❑ OTHERLu <br />a <br />ADDRESS <br />HAS DISCHARGE %3pa jA <br />�o'Ml <br />1 <br />RPAfRTANK ! REPAIRPIPING CHANGE PROCEDURE <br />STREEF 6A C <br />92 <br />ME l <br />0z <br />ao y <br />CONTACTPERSON <br />MATERIAL 5tI i! CAUSE(S) <br />f <br />❑ UNKNOWN <br />FIBERGLASS II[:]❑ <br />❑ !! OVERFILL RUPTUREIFAILURE <br />�TEEL <br />S a <br />d <br />ADDRESS <br />0 2 <br />STREET S � <br />FACILITY NAME (IF APPLICABLE) <br />CTI <br />OPERATOR I'p <br />LU w <br />CHECK ONE ONLY <br />U <br />a <br />CJ <br />v <br />ADDRESS <br />II <br />y <br />OSS STREET <br />STR£Ef CTI <br />TYPE OF AREA ❑ COMMERCIALJXINpUSTRWL <br />�i <br />I <br />❑ RESIDENTIAL ❑ OTHER <br />❑ CAP SITE (CO) ❑ EXCAVATE a DISPOSE (ED) <br />AL AGENCY <br />AGEN Y NAME <br />TACT PER I <br />w <br />1 <br />❑ TREATMENT AT HOOKUP (HU) ❑ NO ACTION REOUIRED (NA) <br />❑ OTHER (OT) <br />TD <br />a <br />REGIONAL BOARD <br />1 CONTAMINATION SITE REPORT <br />lPHHO�N'(E' <br />tY,L.' <br />TYPE OF BUSINESS RETAIL FUEL STATION <br />❑ FARM ❑ OTHER <br />PHONE <br />(ir <br />v I �r�- l Ji <br />p <br />NAME <br />wt <br />i 4 QUANTITY LOST (GALLO S) <br />C <br />- <br />UNKNOWN <br />Z <br />�� <br />— i� UNKNOWN <br />DATE DiSCOVERED How DISCOVERED ❑ INVENTORY CONTROL SUBSURIIFACEMONITORING ❑ NUISANCE CONDITIONS <br />)M <br />2 <br />p N y ❑ TANK TEST ❑ TANK REMOVAL ❑ OTHERI <br />j <br />DATE DISCHARGE BEGAN <br />METHOD USED TO STOP DISCHARGE (CHECK ALL THAT APPLY) <br />ii � <br />} <br />M M p D v Y UNKNOWN <br />❑ REMOVE CONTENTS ❑ REPLACE TANK ❑ CLOSE TANK <br />HAS DISCHARGE %3pa jA <br />�o'Ml <br />1 <br />RPAfRTANK ! REPAIRPIPING CHANGE PROCEDURE <br />Ml a al r r <br />JG3 OTHER <br />tu <br />y <br />SOURCE OF DISCHARGE TANKS ONLY CAPACITY <br />❑ TANK LEAKUNKNOWN <br />MATERIAL 5tI i! CAUSE(S) <br />GAL. <br />❑ PIPiNGLEAK AGE <br />FIBERGLASS II[:]❑ <br />❑ !! OVERFILL RUPTUREIFAILURE <br />�TEEL <br />YRS <br />❑ CORROSION UNKNOWN <br />❑ OTHER ❑ UNKNOWN <br />❑ OTHER t ! ❑ SPILL ❑ OTHER <br />LU w <br />CHECK ONE ONLY <br />U <br />} ! <br />❑ UNDETERMINED ❑ SOIL ONLY GROUNDWATER ❑ DRINKING WATER - (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br />} <br />Z m <br />CHECK ONE ONLY <br />SITE INVESTIGATION IN PROGRESS (DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS ❑ SIGNED OFF (CLEANUP COMPLETED OR UNNECESSARY) <br />U `° <br />❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS <br />p <br />❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES. <br />CHECK APPROPRIATE ACTION(S) (SEE BACK FOR DETAILS) <br />I <br />4 <br />❑ CAP SITE (CO) ❑ EXCAVATE a DISPOSE (ED) <br />❑ REMOVE FREE PRODUCT (FIV ❑ ENHANCED BIO DEGRADATION (IT) <br />❑ CONTAINMENT BARRIER (CB) ❑ EXCAVATE a TREAT (ET) <br />❑ PUMPS TREAT GROUNDWATER (GT) ❑ REPLACE SUPPLY (RS) <br />❑ TREATMENT AT HOOKUP (HU) ❑ NO ACTION REOUIRED (NA) <br />❑ OTHER (OT) <br />TD <br />�f <br />
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