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LIEU <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCAL AGENCY USE ONLY " <br /> ® YES ® NO REPORT BEEN FILED ZYES ® � 1 HEREBY CERTIFYTHAD HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE <br /> DISTAIBUTKON SHOWN ON THE INSTRUCTION SH56 ON THE BACK P OF THIS FOAM <br /> REPORT DATECASE* <br /> 1 0 ,A 2 d 7 49 4 r slGxEu• a1TE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE <br /> E3�- <br /> ® C. Susi Jackson (510 ) 423-6577 <br /> REPRESENTING ® OWNERIOPERATOR ❑ REGION&ZOARO COMPANY OR AGENCY NAME <br /> 2 ❑ LOCAL AGENCY ❑ OTHER University of California <br /> Uj <br /> 11Aw.CR.mBox 808 L-633 sTmET 7000 East Ave. cmLivermore STATE CA z,94550 <br /> W NAME CONTACT PERSON PHONE <br /> J <br /> ZDennis R. Fisher ❑ C. Susi Jackson (510 ) 423-6577 <br /> �s a <br /> ADDRESS <br /> W <br /> P.O. Box 808 L-668 sTv u 7000 East Ave. c" Livermore sTATECA Z24550 <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Lawrence Livermore National Laboratory <br /> S tA 300. Building 865 <br /> Dennis R. Fisher (510 )422-3343 <br /> ADDRESS <br /> Corral Hollow Road s wu arrSouth of Tracy cou <br /> GROSS STREET <br /> Interstate 580 <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> WR <br /> an Joaquin County Public Health Service William Snavely1209 )468-0336 <br /> W <br /> REGIONAL BOARD PHONE <br /> Central Valley RW CB Susan Timm k6 )255-3057 <br /> H (1) NAME QUANTITY LOST(GALLONS) <br /> wDiesel Fuel ® UNKNOWN <br /> ❑ UNKNOWN <br /> w DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ® SUBSURFACE MONITORING ® NUISANCE CONDITIONS <br /> 1 0 2 0 0 9 4 „ ❑ TANK TEST ® TAW REMOVAL CE OTHER Diesel Fuel Smell in soil. <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> W <br /> M o v ® UNKNOWN ®REMOVE CONTENTS ®CLOSE TANK&REMOVE ®REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED? ®REPAIR TANK ❑CLOSE TANK d FILL IN PLACE ®CHANGE PROCEDURE <br /> YES ® NO OF YES.DATEM' UNj r r ®REPLACE TANK ®OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ® TANK LEAK ® UNKNOWN ® OVERFILL ® RUPTUREIFAILURE ® SPILL <br /> v ® PIPING LEAK ® OTHER ❑ CORROSION ❑ UNKNOWN ❑ OTHER <br /> w w CHECK ONE ONLY <br /> to ❑ UNDETERMINED ® SOIL ONLY ® GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY �. <br /> ® NO ACTION TARN ® PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION �� <br /> ccy ® LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ® POST CLEANUP MONITORING IN PROGRESS <br /> V ❑ REMEDIATION PLAN ® CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ® CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTON(S) <br /> aM a+ac we 0lv1et81 F7 EXCAVATE&DISPOSE;ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED 1310 DEGRADATION(IT) <br /> ❑ CAP SITE(CD) ® EXCAVATE&TREAT(ET) ❑ PUMP A TREAT GROUNDWATER(GT)® REPLACE SUPPLY(RS) <br /> < ® CONTAINMENT BARRIER(CB) ❑ NO ACTION REOUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ® <br /> VACUUM EXTRACT(VE) ® OTHER(OT) Remove tank. Overexcavate as indicated by William Ina ely <br /> resultsand the of soa sample ana yses. <br /> z <br /> u The tank and some contaminated fill have been removed. We will bore holes through the <br /> 38 underlying concrete slab and collect and analyse soil samples to determine if removal <br /> of the slab and additional soil is needed. <br /> "Sc 03 lagw <br />