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COMPLIANCE INFO_FILE 3
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231945
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COMPLIANCE INFO_FILE 3
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Last modified
12/19/2022 4:38:41 PM
Creation date
6/3/2020 9:55:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
FILE 3
RECORD_ID
PR0231945
PE
2361
FACILITY_ID
FA0003934
FACILITY_NAME
Lawrence Livermore National Lab - Site 300
STREET_NUMBER
15999
Direction
W
STREET_NAME
CORRAL HOLLOW
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
15999 W CORRAL HOLLOW RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231945_15999 W CORRAL HOLLOW_FILE 3.tif
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EHD - Public
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INSTRUCTIONS <br /> EMERGENCY CURRENT STATUS <br /> n i�d'cate whether emergency response personnel and equipment were involved at Indicate the category which best describes the current status of the case. <br /> any time.. if so, a Hazardous Material Incident Report should be filed with Check one asely. The response should be relative to the case type. For <br /> the State Office of Emergency Services (DES) at 2800 Meadowview Road, example, iff case type is "Ground Water",then "Current Status" should refer to. <br /> Sacramento, 'CA 95832. ,Copies;of the DES report formmaybe obtained at your the status of the ground water investigation or cleanup, as opposed to that of <br /> local underground storage tank permitting agency. .Indicate whether the DES soil. <br /> report has been filed as of the date of this report. <br /> IMPORTANT: THE INFORMATION PROVIDED`ON THIS FORM IS INTENDED FOR GENERAL <br /> LOCAL AGENCY ONLY STATISTICAL PURPOSES ONLY AND ISNOT TO BE CONSTRUED AS REPRESENTING THE <br /> To avoid dup'icate notification pursuant to Health and Safety Code Section OFFICIAL POSITION OF ANY GOVERNMENTAL AGENCY <br />" 25180:7, a designated government employee should sign and date the form in <br /> this block. A signature here does not mean that the leak has been determined REMEDIAL ACTION <br /> to pose'a significant threat to Fuman health or safety, only that notification Indicate which actions have been used to cleanup or remediate the leak.+ <br /> procedures have been followed if'required. Descriptions of options follow: <br /> REPORTED BY Cap Site - install horizontal impermeable layer to reduce rainfall <br /> hteer your name, telephone number, and address. Indicate which party you inkration. <br /> represent and provide company or agency name. Containment Barrier - install vertical dike to block horizontal movement <br /> of contaminant. <br /> RESPONSIBLE PARTY Excavate and Dispose - remove contaminated soil and dispose in approved <br /> Enter name, tele-phone number, contact person, and address of the party site. <br /> responsible for the leak. The responsible party would normally be the tank Excavate and Treat- remove contaminated soil and treat (includes <br /> owner.' spreading or land farming). <br /> Remove Free Product - remove floating product from water <br /> SITE LOCATION <br /> nter 5 ormation regarding the tank facility and surrounding area. At a Pump and Treat Groundwater - generally employed to remove dissolved <br /> minimum, you must provide the facility name and full address. contaminants. <br /> ' Enfianced Biode9r-ad-ation - use of any..available technology to promote <br /> IMPLEMENTING AGENCIES bacteria d�amposition of contaminants. <br /> Enter names of t e oval agency and Regional Water Quality Control Board Replace Supply - provide alternative water supply to affected <br /> involved. parties. <br /> Treatment at Hookup - install water treatment devices at each dwelling or <br /> SUBSTANCES INVOLVED othe.rplace ofuse. <br /> titer the name and quantity lost of the hazardous substance involved. Room isNo Action Re uq ired - incident is minor, requiring no <br /> provided for information;on two substances if appropriate. If more than two reme ra action. <br /> substances leaked, list the two of most concern for cleanup. <br /> COMMENTS - Use this space to elaborate on any aspects of the incident. <br /> DISCOVERY/ABATEMENT "' STGU URE - Sign the form in the space provided._ <br /> rovide information regarding the discovery and abatement of the Leak. DISTRIBUTION <br /> SOURCE/CAUSE If the form is completed by the tank owner or his agent, retain the last copy <br /> n ed°icate sources) of leak. Provide details on tank age; capacity and; and forward the remaining copies in tact to your local tank permitting agency <br /> material if known. Check box(es) indicating cause of leak. for distribution. <br /> I. Original - Local 'Tank Permitting Agency <br /> CASE TYPE' 2. State Water Resources Control Board, Division of Water Quality, <br /> Indicate the case type category for this leak. Check one box only. Case type Underground Tank Program, P. 0. Box 1 00, Sacramento, CA 95801 <br /> is based on the,most sensitive resource affected. For example,:if both soil 3. Regional Water Quality Control Board <br /> and ground water have been"affected, case type will be "Ground Water". 4. County Board of Supervisors or designee to receive Proposition 65 <br /> Indicate "Drinking Water" only if one or;more municipal or domestic water notifications. <br /> wells have actually been affected. A "Ground Water" designation does not 5. Owner/responsible party. <br /> imply that the affected water cannot be, or is not, used for drinking water, <br /> but only that water wells have not yet been affected. It is understood that <br /> case type may change upon further investigation. <br />
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