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4/19/22, 8:10 AM GeoTracker <br />STATE <br />WATER <br />ORESOURCES <br />A <br />TRAC KE <br />RD <br />G ER <br />UST C<:;" rices to U,% ESi %cln < r on lz <br />(.Ii,.r *( = G.�^T.ac,..r <br />CASE SUMMARY <br />REPORT DATE HAZARDOUS <br />MATERIAL INCIDENT REPORT FILED WITH OES? <br />1/2/1991 <br />I. REPORTED BY - <br />CREATED BY <br />UNKNOWN <br />UNKNOWN <br />III. SITE LOCATION <br />FACILITY NAME <br />FACILITY ID <br />JACKPOT <br />FACILITY ADDRESS <br />ORIENTATION OF SITE TO STREET <br />13475 JACKTONE RD N <br />LODI, CA 95241 <br />CROSS STREET <br />SAN JOAQUIN COUNTY <br />HARNEY LANE <br />V. SUBSTANCES RELEASED / CONTAMINANT(S) OF CONCERN <br />GASOLINE <br />VI. DISCOVERY/ABATEMENT <br />DATE DISCHARGE BEGAN <br />DATE DISCOVERED <br />HOW DISCOVERED DESCRIPTION <br />1/2/1991 <br />Tank Closure <br />DATE STOPPED <br />STOP METHOD DESCRIPTION <br />VII. SOURCE/CAUSE <br />SOURCE OF DISCHARGE <br />CAUSE OF DISCHARGE <br />DISCHARGE DESCRIPTION <br />VIII. CASE TYPE <br />CASE TYPE <br />Soil <br />IX. REMEDIAL ACTION <br />NO REMEDIAL ACTIONS ENTERED <br />X. GENERAL COMMENTS <br />XI. CERTIFICATION <br />I HEREBY CERTIFY THAT THE INFORMATION REPORTED HEREIN <br />IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. <br />XII. REGULATORY USE ONLY <br />LOCAL AGENCY CASE NUMBER <br />REGIONAL BOARD CASE NUMBER <br />1635 <br />390555 <br />LOCAL AGENCY <br />UNKNOWN <br />REGIONAL BOARD <br />CONTACT NAME INITIALS <br />ORGANIZATION NAME EMAILADDRESS <br />Alan Buehler AMB <br />CENTRAL VALLEY RWQCB (REGION 5S) alan.buehler@waterboards.ca.gov <br />ADDRESS <br />CONTACT DESCRIPTION <br />11020 SUN CENTER DRIVE #200 <br />Regional Board Case Worker <br />RANCHO CORDOVA, CA 95670-6114 <br />PHONETYPE <br />PHONE NUMBER EXTENSION <br />FAX <br />(916)1164-0704 <br />OFFICE <br />(916)-464-4615 <br />https://geotracker.waterboards.ca.gov/case_su mmary?global_id=T0607700439 1/1 <br />