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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) /CONTAMINATION SITE REPORT <br /> EMERGENCY iAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> — YES REPORT BEEN FILED? ES I-T No I HEREBY CERTIFY THAT 1 AM A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> 'NO REPORTED THIS INFORMATION TO LOCAL OFFICIALS PURSUANT TO SECTION 25180.7 OF <br /> REPORT DATE CASE x THE HEALTH AND SAFTY CODE <br /> 0 Mi 5M1 2 a 6 of 8 Y'I 9 YI SIGNED <br /> DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE <br /> > Connie DeGran e � (415) 422-5167 <br /> m <br /> o REPRESENTINGI 7XOWNER OPERATOR REGIONALBOARD COMPANY OR AGENCY NAME <br /> 0 ❑'' LOCAL AGENCY ❑ OTHER University of California <br /> a <br /> ADDRESS <br /> 7000 East Avenue cry Livermore CA 94550 <br /> P.O. Box 808, L-193 STREET <br /> STATE ZIP <br /> LU NAME CONTACTPERSON PHONE <br /> ZQ j Dennis K. Fisher ❑ UNKNOWN Connie DeGrange ( 415) 422-5167 <br /> g a ADDRESS <br /> LU <br /> Cr P.O. Box 808, L-193 7000 East Avenue Livermore, CA 94550 <br /> STREET CTI <br /> STATE Zip <br /> FACILITY NAME(IF APPLICABLE) Building 850 OPERATOR PHONE <br /> o Lawrence Livermore National Laboratory Dennis K. Fisher ( 415) 422-8351 <br /> U ADDRESS Located 15 miles east of Livermore on <br /> 8 Corral HollowT&ad gym, Tracy San JoaquiCOUNTYPn <br /> y CROSS STREET TYPE OF AREA ❑COMMERCIAL ❑ INDUSTRIAL ❑ RURAL TYPE OF BUSINESS <br /> ❑ RETAIL FUEL STATION <br /> ❑RESIDENTIAL ®OTHER Federal Lab ❑ FARM ❑ OTHER Research <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> y San Joaquin Local Health District <br /> LLI <br /> w Laurie Cotulla ( 209) 468-3432 <br /> Lu LLJ REGIONAL BOARD <br /> � PHONE <br /> a <br /> Central Valley RWQCB Mike Higgins <br /> ( 916) 361-5653 <br /> N (1) NAME QUANTITY LOST(GALLONS) <br /> w0' <br /> ® UNKNOWN <br /> 2 0j (2) <br /> Z ❑ UNKNOWN <br /> z DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> w O M SMI 2D1 3 D 8 v 9 v ❑ TANK TEST ❑ TANK REMOVAL OTHER Analysis of soil samples <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> w M MI DI DI Y1 Y1 Ez UNKNOWN ❑ REMOVECONTENTS ❑ REPLACE TANK ❑ CLOSE TANK <br /> p HAS DISCHARGE BEEN STOPPED? Summer Of 1985 ❑ REPAIRTANK ❑ REPAIRPPNG ❑ CHANGE PROCEDURE <br /> p E3� YES ❑ NO IFYES•DATE M1 M' DI o YI v OTHER Tank was removed In 1985 <br /> wSOUR OF DISCHARG TANKS ONLY�CAPACITY MATERIAL CAUSE(S) <br /> 0 uspecte 1000 <br /> ® TANK LEAK UNKNOWN GAL. ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE <br /> ❑ PIPING LEAK AGE X 18 YRS ❑X STEEL ❑ CORROSION a UNKNOWN <br /> ❑ OTHER ❑ UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER <br /> WW CHECK ONE ONLY <br /> a <br /> v ❑ UNDETERMINED SOIL ONLY �❑ GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> F CHECK ONE ONLY <br /> Zy <br /> a CrF SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> cc <br /> U h ❑ NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVALABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) <br /> 4 4 ❑ CAP SITE(CD) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> ❑ TREATMENT AT HOOKUP(HU) ❑ NO ACTION REOUIRED(NA) ❑ OTHER(OT) <br /> The tank was removed in 1985. Results from recent soil samples were received on 5-23-8 <br /> Z and showed soil to be contaminated with diesel fuel to a depth of at least six feet <br /> 2below the tank excavation. The type of remedial action that is necessary is being <br /> determined. <br /> NSC 05(41,67l <br />