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�a <br /> o-4 {` ' <br /> b <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED EL E(LEAK)ICO TA I A N Sal I . Z`_ . <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICESQGYM. ;R E a+y < + <br /> O ® � REPORT BEEN FILED? 0 YES NO 1IEREB'w UE}TT1FY.7HAT t 4M A CIEStC�NATEO GCl1►EANMENTEMP(OYEE.AN[1 T(91T)HAVE:: <br /> YES R t3 F#(tS(NF: T .I OCA[ IFF(G(ALu PURSUANT TO SECT 2St8Q7 OF <br /> REPORT DATE CASE# THE HEALTH AND SAiFi`f COD <br /> 0 M 5 M 2 0 0 9 Y 2 Y &LNE� ..: : .. .:. TE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGN TORE <br /> C. Susi Jackson ( 510) 423-6577 <br /> ® A .5. <br /> 6 <br /> W REPRESENTING ❑X OWNER/OPERATOR F-] REGIONALBOARD COMPANY OR AGENCY NAME <br /> g <br /> El LOCAL AGENCY OTHER University of California <br /> a <br /> ADDRESS <br /> P.O. Box 808, L-633, 7000 East Avenue Livermore CA 94550 <br /> STREET CITY STATE ip <br /> Lq NAME CONTACT PERSON PHONE <br /> Dennis K. Fisher UNKNOWN C. Susi Jackson (510 ) 423-6577 <br /> a ADDRESS <br /> M P.O. Box 808, L-668, 7000 East Avenue Livermore CA 94550 <br /> STREET CITY STATE ZIP <br /> FACILITY NAME(IF APPLICABLE) Building OPERATOR PHONE <br /> Z Lawrence Livermore National Lab,-Site 30Dennis K. Fisher P10 ) 422-3343 <br /> Q 11 <br /> ADDRESS <br /> Corral Hollow Rd, So. of Tracy, SanJoaquuin County <br /> STREET CITY I COUNTY <br /> CROSS STREET TYPE OF AREAE]COMMERCIAL Q INDUSTRIALF--]RURAL TYPE OF BUSINESS 0 RETAIL FUEL STATION <br /> Interstate 580 RESIDENTIAL OOTHER Federal Lab 0 FARM FRR OTHER Research <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> r W San Joaquin County <br /> W� Public Health Services William Snavely X209 ) 468-0336 <br /> w REGIONAL BOARD PHONE <br /> Central Valley RWQCB Wendy Cohen 016 ) 361-5676 <br /> m (') NAME QUANTITY LOST(GALLONS) <br /> Diesel Fuel } UNKNOWN <br /> X (2) <br /> ❑ UNKNOWN <br /> r- GATE DISCOVERED HOW DISCOVERED � ® NUISANCE CONDITIONS <br /> z INVENTORY CONTROL SUBSURFACE <br /> 2 0 M 5 M 1 D 3 p 9 2 r TANK TEST ® TANK REMOVAL OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> w <br /> M1 M1 DI DI Y1 Yj RjQ UNKNOWN Q REMOVE CONTENTS a REPLACE TANK ® CLOSE TANK <br /> HAS DISCHARGE BEEN STOPPED? Unknown 0 REPAIR TANK ❑ REPAIR PIPING CHANGE PROCEDURE <br /> p YES ❑ NO IFYES,DATE MI M1 DI DI Y Y ❑ OTHER <br /> N SOURCE OF DISCHARGE TANKS ONLY/CAPACITY MATERIAL CAUSES) <br /> TANK LEAK F-] UNKNOWN 2000 GAL. � FIBERGLASS OVERFILL RUPTUREIFAILURE <br /> U� F--] PIPING LEAK AGE 'i5 YRS F STEEL - ,❑ CORROSION UNKNOWN <br /> OTHER overfill UNKNOWN 0 OTHER SPILL [::] OTHER <br /> WW CHECK ONE ONLY <br /> V <br /> Ng UNDETERMINED E::], SOIL ONLY Q GROUNDWATER Q DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> z CO <br /> Q< R2 SITE INVESTIGATION IN PR�RESS(DEFINING EXTENT OF PROBLEM) 0 CLEANUP IN PROGRESS❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> U F--] NO ACTION TAKEN 0 POST CLEANUP MONITORING IN PROGRESS NO FUNDS AVAILABLE TO PROCEED E EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTON(S)(SEE BACK FOR DETAILS) <br /> ❑ CAP SITE(CD) F-� EXCAVATE&DISPOSE(ED) Q REMOVE FREE PRODUCT(FP) ENHANCED BO DEGRADATION(IT) <br /> ❑ CONTAINMENT BARRIER(CB) E:] EXCAVATE&TREAT(ET) 'PUMP&TREAT GROUNDWATER(GT) E] REPLACE SUPPLY(RS) <br /> TREATMENT AT HOOKUP(HU) 0 NO ACTIONAEQUIRED(NA) Q OTHER(OT) <br /> The releases are believed to be related to historic overfill eve - <br /> There is no recent evidence of leakage or s llage� .5'6i4 g <br /> � < <br /> HSCOS(ara7) <br />