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0 0 <br /> JNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> 1 =MERGENCY -AS STATE OFFICE OF EMERGENCY SERVICES <br /> ES NO ;SRT BEEN FILED 7 FOR LOCAL AGENCY USE ONLY <br /> YES I NO IHEREBY CERTiFYTHATI HAVE DISTRIBUTED THIS INFCRAUTIONACC�Dr,�,ToTHE <br /> REPORT OATS CASE. DISMIBUTICN SHOWN CN THE INSTRUCTION SHEET ON THE BACK PAW OF <br /> TM <br /> 0 u 3 0 3 9 <br /> I '.AME OF INDIVDJAL FILING REPORT <br /> PHONE 6ATi <br /> SIGNATURE <br /> C. Susi Jackson <br /> ;EPRESENTING (510 ) 423-6577 <br /> _JNERrOPERATOR REGIONAL BOARD I COMPANY OR AGENCY NAME <br /> Q I OCALAGENCY I OTHER <br /> ADDRESS University of California <br /> 1 ?.0. Box 808 --633,w, 7000 East Ave. <br /> NAME cry Livermore STATE CA. 455 <br /> CONTACT PERSON PHONE <br /> z¢ Dennis K. Fisher ❑ UNKNOWN C. Susi Jackson <br /> �� ADDRESS <br /> I (510 ) 423-6577 <br /> u <br /> S P.O. Box 808, L-633 ,m 7000 East i Ave.:ACILI-Y NAME(IF APPLICAB� �,� Livermore srA� CA 9 50 <br /> Lawrence Livermore National Laboratory OPERATOR PHONE <br /> Site 300 Building 871 <br /> a -L REss Dennis K. Fisher ! (510 ) 422-3343 <br /> Corral Hollow Road South ofTracySan Joaquin <br /> C'OSS STREET <br /> couarr <br /> -nterstate 580 <br /> O FOCAL AGENCY <br /> ?�I _'�E CUNTACi tno W <br /> OHONIP <br /> pllE11iC Healt'i `= r � v r <br /> dOAAO - <br /> _Public - -- - .i 1_i_sm Knave iv 209 "; 46ri-0336 I <br /> Central valley RWOCB Susan Ti:� t <br /> ; k 916 ) 255-3057 <br /> < �IL C NAME OUANTTTY LOST(GALLONB) <br /> Diesel Fuel <br /> ?I <br /> I <br /> LATE C SCOVERED z UNKNOWN i HOW DISCOVERED <br /> 1 i _ INVENTORY CONTROL _ SUBSURFACE MONITORING —I NUISANCE CONDITIONS <br /> 2 ob 9 4 "ANKTEST TANK REMOVAL OTHER <br /> :ATSmell <br /> Of DiPRPI f„pl in Qoil <br /> a E L.SCHARGE BEGAN <br /> 1 METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> _ UNKNOWN REMOVE CONTENTS <br /> u L✓ IT CLOSE TANK L REMOVE REPAMI PIPING <br /> C� I HAS D'SCHARGE BEEN STOPPED 7 <br /> Yf i <br /> `_' I ���—V� Tank Pumped REPAIR TANK CLOSE TANK i FILL IN PLACE C CHANGE PROCEDURE <br /> 5 -A- -ES I NO IF YES,DATE <br /> o I 0 ul 7 ,. 2 1 9 714y L-]REPLACE TANK OTHER <br /> SOURCE OF DISCHARGE v <br /> N _ CAUSE(S) <br /> Z, i TANK LEAK UNKNOWN <br /> < ® OVERFILL 1:1 RUPTUREIFAILURESPILL <br /> PIPING LEAK OTHER f '1 <br /> U CORROSION <br /> UNKNOWN OTHER <br /> u+w CHECK ONE ONLY <br /> ti a <br /> U� � UNDETERMINED _7X SOIL ONLY <br /> GROUNDWATER = DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Z i^ NO ACTION TAKEN PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED <br /> w O <br /> C POLLUTION CHARACTERIZATION <br /> Cr '_EAK BEING CONFIRMED © PRELIMINARY SITE ASSESSMENT <br /> v " UNDERWAY POST CLEANUP MONITORING N PROGRESS <br /> REMEDIATK)N PLAN CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) <br /> i CHECK APPROPRIATE ACTION(S) I CLEANUP UNDERWAY <br /> IN"01� u WTAEXCAVATE i DISPOSE(ED) J REMOVE FREE PRODUCT F <br /> p p I CAP SITE(cD) ( P) ENHANCED BIO DEGRADATION(IT) <br /> w EXCAVATE A TREAT(ET) J PUMP A TREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) <br /> w a CONTAINMENT BARRIER(CB) <br /> _ NO ACTION REOUIRED(NA) � TREATMENT AT HOOKUP(HLA) I� VENT 500.(VS)':ACUUMEX7RACT(VE) NO <br /> OTHER(OT) Remove tank—& overexcavate <br /> Sensory evidence suggested dispersed contamination in the bottom of the excavation. <br /> � z : Suspected impacted soil was excavated and sampled. Tank testing had shown this tank <br /> I < <br /> ; to be leak tight. <br /> "SC 05 4"% <br />