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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICESfQR LOCM AGENCY VS.E. IY <br /> REPORT BEEN FILED 9 1 HEREBY CERFIFY?HA7 NAPE:DISTRIBI}TEDTHIS INf.C�RMATION;ACCORQING TO THE <br /> ❑ YES ® NO E] YES ❑ NO pR(gpTlf)N SHOYVNON THE wSTRUCT)DN SHEET oN THE BACK PAGE of THIS FORM <br /> REPORT DATE Ey <br /> t <br /> OM 7 M 1 1 9 4 DATE <br /> SIGNED <br /> NAME OF INDIVIDUAL FILING REPORT PHONE 1 <br /> C. Susi Jackson (510 ) 423-6577 <br /> LU REPRESENTING OWNER/OPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME <br /> g ❑ LOCAL AGENCY ❑ OTHER University of California <br /> � [AiDDRESs <br /> P. <br /> Box 808, L-633 7000 East Ave. Livermore CA 94550 <br /> CITY STATE ZIP <br /> NAME STREET CONTACT PERSON PHONE <br /> Fn Dennis K. Fisher E:] UNKNOWN C. Susi Jackson (510 )423-6577 <br /> a a ADDRESS <br /> Uj P.O. Box 808, L-668 7000 East Ave. Livermore� Ca.gTA 94550 <br /> STREET <br /> TE ZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> z Lawrence Livermore National Laboratory Dennis K. Fisher (510 )422-3343 <br /> o Site 300 Building 80 <br /> 4FADDRESSorral Hollow Road � � South o�rTracyS�an�JoaquinZIP <br /> SS STREET <br /> Interstate 580 <br /> �ry LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> Wel (20 ) 468-0336 <br /> z' Joaquin Count Public Health Servic <br /> s William Snavely <br /> LU z San <br /> L2 w REGIONAL BOARD PHONE <br /> CL <br /> Central Valley RWQCB Susan Timm (916 ) 255-3057 <br /> (�) NAME QUANTITY LOST(GALLONS) <br /> m <br /> ow ❑ UNKNOWN <br /> a Diesel Fuel <br /> o o (2) <br /> y? ❑ UNKNOWN <br /> DATE DISCOVERED NOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> z <br /> O MI 7M O 1 0 9 v 4 Y ❑ TANK TEST TANK REMOVAL ® OTHER Review Soil Sample Analyses. <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> m <br /> g <br /> UNKNOWN CONTENTS I�I CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> y� ❑ ❑REMOVE CONTOLJ <br /> W M M D Y <br /> 0 HAS DISCHARGE BEEN STOPPED 7 F-]REPAIR TANK ❑CLOSE TANK&FILL IN PLACE E]CHANGE PROCEDURE <br /> o ® YES ❑ NO IF YES,DATE 0 M 6 M) 2 0 2 9 Y LI Y ❑REPLACE TANK ❑OTHER, <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> Cr ❑ TANK LEAK ❑ UNKNOWN O OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> 00 ❑ PIPING LEAK ® OTHER ❑ CORROSION ❑ UNKNOWN ❑ OTHER <br /> w w CHECK ONE ONLY <br /> U ❑ UNDETERMINED ® SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> Z <br /> ® NO ACTION TAKEN ❑ PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED E::] POLLUTION CHARACTERIZATION <br /> F-1 POST CLEANUP <br /> PRELIMINARY SITE ASSESSMENT UNDERWAY <br /> U F-1LEAK BEING CONFIRMED ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY MONITORING IN PROGRESS <br /> ❑ REMEDIATION PLAN ❑ OE <br /> CHECK APPROPRIATE ACTIONS) ❑ EXCAVATE S DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> (WE BACK wa MALS) <br /> 0 0 ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP a TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> W <br /> w a�-j ❑ AT HOOKUP CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT (HU) VENT SOIL(YS) <br /> ❑ <br /> ❑ VACUUM EXTRACT(VE) ® OTHER(OT) Removed tank fill, concrete slab, and Soil <br /> The analyses of the soil sample collected from soil and fill gravel excavated at the <br /> underground diesel fuel tank 805-DlUl closure site showed 7.4 mg/kg diesel fuel in the <br /> 2 soil. No diesel fuel was detected in the soil sample collected in the bottom of the <br /> 8 excavation. BTXE was not detected in either sample. <br /> HSC 05(&W <br />