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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)! CONTAMINATION SITE REPORT <br />EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES <br />REPORT BEEN FILED? <br />I I <br />„ <br />I YES I Xr.NO YES NO [ F.}, <br />' FOR ;LOCAL AGENCY USE ONLY <br />1 HEREBY CERTIFY THAT I HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO 4E ' <br />DISTRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM. <br />REPORT DATE <br />l ul 1,41 % 3 9,1 5y <br />CASES <br />SIGHED DATE REPORTED BY NAME OF INDIVIDUAL FILING REPORT <br />John Koch <br />PHONE <br />(519 675-6143 , , .../4 & <br />REPRESENTING FFOWNER/OPERATOR [ I REGIONAL BOARD <br />I I LOCAL AGENCY I 1 OTHER <br />COMPANY OR AGENCY NAME <br />Shell Oil P oducts Company <br />ADDRESS <br />1390 Willow Pass Road, Ste 900; Concord California 94520 STREET CITY STATE ZIP RESPONSIBLE PA Ft NAME <br />Shell Oil Products Compagyi LINICIMAN <br />CONTACT PERSON <br />R. Jeff Granberry <br />PHONE <br />(510)675-6168 <br />ADDRESS <br />1390 Willow Pass Road, Ste 900; Concord California 94520 <br />STREET CITY STATE ZIP SITE LOCATION FACILITY NAME (IF APPLICABLE) <br />Ripon Shell <br />OPERATOR <br />David Posey <br />PHONE <br />(H9)599-4454 <br />ADDRESS <br />341 E. Main Street, Ripon, San Joaquin County 95366 sill. cmy co., m CROSS STREET <br />Highway 99 IMPLEMENTING AGENCIES LOCAL AGENCY AGENCY NAME <br />San Joaquin Env. Hlth. Svcs. <br />CONTACT PERSON <br />Eric Trevtna <br />PHONE <br />(209)468-0333 <br />REGIONAL BOARD <br />RWQCB <br />PHONE <br />( ) ISUBSTANCES IN NAME QUANTITY LOST (GALLONS) gasoline [----f UNKNOWN <br /> <br />I I UNKNOWN 1 CASE I SOURCE/ DISCOVERY/ABATEMENT TYPE CAUSE DATE DISCOVERED <br />1 .1 1.1 0.1 3.1 9! 5y <br />HOW DISCOVERED I 1 INVENTORY CONTROL I I SUBSURFACE MONITORING I I NUISANCE CONDITIONS <br />I I TANK TEST I I TANK REMOVAL r---k OTHER <br />DATE DISCHARGE BEGAN <br />1,41 1 ml 0 01 3DI 9,,,I 54 1 1 UNKNOWN <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 I CLOSE TANK & FILL IN PLACE I I CHANGE PROCEDURE <br />I I REPLACE TANK 770THER piping Capped <br />HAS DISCHARGE BEEN STOPPED? <br />:FX1 YES I I NO IF YES, DATE <br />1 ml 1 L4I ° .1 3 .J 94 5 Y <br />SOURCE OF DISCHARGE <br />I I TANK LEAK I 1 UNKNOWN <br /> <br />gX I PIPING LEAK I 1 OTHER <br />CAUSE(S) <br />1 I OVERFILL I 1 RUPTURE/FAILURE I SPILL <br />I I CORROSION I I UNKNOWN ['OTHER <br />CHECK ONE ONLY <br />11..X UNDETERMINED I I SOIL ONLY GROUNDWATER F-7 DRINKING WATER - (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) ICURRENT STATUS CHECK ONE ONLY <br />I I NO ACTION TAKEN I I PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED I I POLLUTION CHARACTERIZATION <br />I I LEAK BEING CONFIRMED 77. PRELIMINARY SITE ASSESSMENT UNDERWAY I I POST CLEANUP MONITORING IN PROGRESS <br />I I REMEDIATION PLAN I 1 CASE CLOSED (CLEANUP COMPLETED OR UNNECESSARY) I I CLEANUP UNDERWAY REMEDIAL ACTION CHECK APPROPRIATE ACTION(S) I I EXCAVATE & DISPOSE (ED) I I REMOVE FREE PRODUCT (FP) I I ENHANCED BID DEGRADATION (IT) PEE eACK FOB DETALS) <br />I CAP SITE (CD) I I EXCAVATE & TREAT (ET) I I PUMP & TREAT GROUNDWATER (GT) I I REPLACE SUPPLY (RS) <br />I CONTAINMENT BARRIER (CB) Li NO ACTION REQUIRED (NA) I TREATMENT AT HOOKUP (HU) I 1 VENT SOIL (VS) <br />1 I VACUUM EXTRACT (VE) F-0.MM(OT) site investigation in progress. COMMENTS HSC 05(8/90)