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UNDERGROUND STORAGE TANWOAUTHORIZED RELEASE(LEAK)/CO MINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FORLOCAI AGENCX USE <br /> YES ® NO REPORT BEEN FILED TYES® ® NO (HEREBX CERTYTHAT FIAVE t1�5TR�UTEO:fiHIS INFOViMATiON ACCORoax3 70 3 FIE <br /> ®ISTA�UTiON SHOWNOtrt PFS N(STRUCYIDN.SHEFT ON THE BACK PAGE OF THIS FORT <br /> REPORT DATE CASE a <br /> 0 3M 2 5 9 4 SIGNED:: DATE <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SN'sN <br /> C. Susi Jackson 010 ) 423-6577 —r <br /> ® REPRESENTING ® OWNERIOPERATOR ® REGIONAL BOARD COMPANY OR AGENCY NAME <br /> g ❑ LOCAL AGENCY ❑ OTHER University of California <br /> 'Cr ADDRESS <br /> I <br /> P.O. Box 808, L-633 7000 East Avenue Livermore CA 94550 <br /> STREET CRY STATE MP <br /> w NAME CONTACTPERSON PHONE <br /> J <br /> Dennis K. Fisher ❑UNKNOWN C. Susi Jackson ( 510) 423-6577 <br /> 0.. ADDRESS <br /> Cr P.O. Box 808, L-6 68 7000 East Avenue Livermore CA 94550 <br /> STREET CRY STATE ztp <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Lawrence Livermore National Laboratory <br /> Site 300 Building 836 IDennis K. Fisher 1610 )422-3343 <br /> ADDRESS <br /> Corral Hollow Road South of Tracy San Joaquin <br /> yCROSS STREET $TRW J COUNTY MP <br /> Interstate 580 <br /> p LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> W W San Joaquin Count Public Health Services William Snavely ( 209)468-0336 <br /> REGIONAL BOARD PHONE <br /> Central Valley RWQCB Susan Timm ( 916) 255-3057 <br /> y (1) NAME QUANTITY LOST <br /> Diesel Fuel <br /> UNKNOWNH <br /> UNKNOWN <br /> z DATE DISCOVERED HOW DISCOVERED ® INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> 2 04 3 .11 4 8 ,,j 9 4 Y ❑ TANK TEST ® TANK REMOVAL ® OTHER <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> 2d d A A ® UNKNOWN ❑REMOVE CONTENTS ®CLOSE TANK 6 REMOVE ❑REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED 9 ❑REPAIR TANK ❑CLOSE TANK a FILL IN PLACE ❑CHANGE PROCEDURE <br /> to <br /> ® YES ❑ NO IF YES.DATE 0 M 3 1 1 9 Y 4 Y ❑REPLACE TANK OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ❑ TANK LEAK ❑ UNKNOWN ® OVERFILL RUPTURE/FAILURE ❑ SPILL <br /> u�O ❑ PIPING LEAK ® OTHER ❑ CORROSION ❑ UNKNOWN ❑ OTHER <br /> w a CHECK ONE ONLY <br /> ❑ UNDETERMINED ® SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> ® NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED ® POLLUTION CHARACTERIZATION <br /> ccis ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ® POST CLEANUP MONITORING IN PROGRESS <br /> ti ❑ REMEDIATION PLAN ® CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) <br /> (sEE ❑ ENHANCED BIO DEGRADATION(IT) <br /> � slue tae CETA6Ai <br /> L9 0 ❑ CAP SITE(CD) EXCAVATE&TREAT(ET) ❑ PUMP 6 TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> W< ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> a ® VACUUM EXTRACT(VE) ® OTHER(OT) Remove tank & overexcavate <br /> f2 Sensory evidence suggested dispersed contamination in the bottom of the excavation. <br /> WSuspected impacted soil was excavated and sampled. Tank testing had shown this tank <br /> $ to be leak tight. <br /> "Sc 05 IS" <br />