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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/ CONTAMINATION SITE REPORT EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY REPORT BEEN FILED 7 YES +;O — ' — YES NO ;E7EBY CERTIFY THAT I HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE REPORT DATECASE# 1STRIBUTION SHOWN ON THE INSTRUCTION SHEET ON THE BACK PAGE OF THIS FORM. j ! 77 - H uO :, 3 ~ 9r 4v! �GNcD DATE OF INDIVIDUAL FILING REPORT PHONE SIGNATURE >- iC. Susi Jackson (510 ) 423-6577. C REPRESENTING COMPANY OR AGENCY NAME ✓�� \ OWNER/OPERATOR I_ REGIONAL BOARD F \ a LOCAL AGENCY ❑ OTHER , LU ADDRESS Universit of California P.O. Box 808, L-633 STREET 7000 East Ave. �,� Livermore STATE CA 94550 J I NAME a CONTACT PERSON PHONE ZIDennis K. Fisher UNKNOWN C. Susi Jackson (510 ) 423-6577 Oa ADDRESS LU !P.O. Box 808, L-633 eTREET 7000 East Ave. ry Livermore STATE CA 94550 FACILITY NAME(IF APPLICABLE) CPERATOR ;Lawrence Livermore National laboratory j PHONE o ;Site 300 Building 834 Dennis K. Fisher 1 (510 ) 422-3343 ADDRESS U I I W !Corral Hollow Road STREET _ South of Trac San Joaquin Tracy COUNTY q ZIR CROSS STREET Interstate 580 z LOCALAGENCY AGENCY NAMENTACTPERSON PHONE H N UjZ San Joaquin Count Public Health Service's William Snavely (209 ) 468-0336 w W REGIONAL BOARD PHONE as Central Valley RWQCB Susan Timm I (916 ) 255-3057 LLJ U) II) NAME w p QUANTITY LOST(GALLONS) Diesel Fuel UNKNOWN r CO o (Z) ❑ UNKNOWN DATE DISCOVEREDHOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING i❑ NUISANCE CONDITIONS 10 ',. 7 ., 2 o 7 of 9 YI 4 r ❑ TANK TEST TANK REMOVAL Xj OTHER Smell Of diesel fuel in soil DATE DISCHARGE BEGAN V ETHOO USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) a U j ri UNKNOWN _ REMOVE CONTENTS J CLOSE TANK 8 REMOVE ❑REPAIR PIPING HAS DISCHARGE BEEN STOPPED? Tank Pumped _REPAIR TANK ❑CLOSE TANK 8 FILL IN PLACE ❑CHANGE PROCEDURE a j YES !_ NO IF YES,DATE Oml 7.! 2 11 9 vI 4,1 _REPLACE TANK ❑ OTHER w SOURCE OF DISCHARGE CAUSE(S) w N ❑ UNKNOWN D a TANK LEAK �� OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL N O PIPING LEAK -7 OTHER CORROSION ❑ UNKNOWN L OTHER w w CHECK ONE ONLY N a L) UNDETERMINED ❑ SOIL ONLY GROUNDWATER DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) CHECK ONE ONLY zN z % NO ACTION TAKEN (❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION LEAK BEING CONFIRMED PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS U v1 j REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETE?OR UNNECESSARY) ❑ CLEANUP UNDERWAY CHECK APPROPRIATE ACTION(S) ❑ rU BACK FOR DETAlS) EXCAVATE 8 DISPOSE,E:+ J ( )REMOVE FREE PRODUCT FP ❑ ENHANCED BIODEGRADATION(IT) . a O CAP SITE(CD)_ LU o ❑ EXCAVATE 8 TREAT(E t PUMP d TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) w a CONTAINMENT BARRIER( ) NO ACTION REQUIRED(NA _ CB ❑ 1 ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) VACUUM EXTRACT(VE) OTHER(OT) Remove tank & overexcavate iExcavATION SMELLED OF DIESEL FUEL. SUSPENDED IMPACTED SOIL WAS EXCAVATED AND SAMPLED. w IDIESEL FUEL ALSO IDENTIFIED IN GROUNDWATER FROM NEARBY DOWNGRADIENT WELL MONITORING Om IAN 18 FOOT DEEP PERCHED AQUIFER. TANK TESTING HAD SHOWN THIS TANK TO BE LEAK TIGHT. U HSC 051"0)