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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES fOR AGENCX USE ONLY <br /> ❑ YES [�j NO REPORT BEEN FILED? YES ® NO <br /> IHAVE DISTR1BtlTEDTHiS iNftMA AG TO THE: <br /> THE)f!!S'TRl1 SHEET�I TIRE P K�THIS FORME s <br /> REPORT DATE CASE s <br /> OA 7 ml 1 4 1 <br /> NAME OF INDIVIDUAL FILING REPORT PHONE S <br /> > C. Susi Jackson 1 ( 510)423-6577 <br /> ❑ OWNERbPERATOR ❑ <br /> REPRESENTING REGIONAL BOARD COMPANY OR AGENCY NAME <br /> ❑ <br /> LOCAL ACENCY ❑ OTHER University of California <br /> ADDRESS <br /> P.O. Box 808, L-633 7000 East Ave. Livermore A 94550 <br /> tar CITY ATS ZIP <br /> W NAME CONTACT PERSON PHONE <br /> Dennis K. Fisher ❑UNKNOWN C. Susi Jackson X10 )423-6577 <br /> ADDRESS <br /> Q 0. P.O. Box 808, L-668 7000 East Ave Livermore �A� 94550 <br /> STFIEff AZIP <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Lawrence Livermore National Laboratory <br /> Site '100- Building 927� ( 10 ) 422-3343 <br /> q ADDRESS <br /> Corral Hollow Road South of Tracy San Joaquin <br /> SrRW cmr OOVMY <br /> CROSS STREET <br /> Interstate 580 <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> W W San Joaquin County Public Health Services William Snavely (209 ) 468-0336 <br /> w 1 REGIONAL BOARD PHONE <br /> a Central Valley RWQCB Susan Timm (916 ) 255-3057 <br /> ua nr NAME OUANTITY LOST( <br /> Diesel Fuel ❑ UNKNOWN <br /> y ® UNKNOWN <br /> a DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> 0 7„ 0 1 ® y (E v ❑ T TEST TA OVAL ® OTHERReyiew Soil Sample Analyses <br /> m DATE DISCHARGE BEGAN METHOD USED TO STOP DI (CHECK ALL THAT APPLY) <br /> UNKNOWN ®REMOVE TENTS �CLOSET &REMOVE ❑REPAIR PIPING <br /> HAS DISCHARGE BEEN STOPPED? ❑REPAIR TANK ❑CLOSE TAW&FILL IN PLACE ❑04ANM PROCEDURE <br /> G YES El NO IF YES.DATE 0 6 j 2 d 2 j 9 1 4 ,1 ❑REPLACE TANK ❑OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> TANK LEAK D UNKNOWN 0 OVERFILL ® RUPTUREFAILURE ❑ SPILL <br /> ❑ PIPING LEAKx❑ OTHER EDCORROSION ❑ UNKNOWN ❑ OTHER <br /> W w CHECK ONE ONLY <br /> ❑ UNDETERMINED ❑ SOIL ONLY ❑ GROUNDWATER ® DRINKING WATER-(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> W <br /> U � NO ACTION TAKEN ® PRELIMINARY SITE ASSESSMENT SUBMITTED ® POLLUTION CHARACTERIZATION <br /> cc m ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS <br /> U ❑ REMEDIATION PLAN ❑ CASE CUED TED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DIS (EO) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(17) <br /> (M SAM fcR MTMM <br /> o ® CAP SITE(tom} EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> LU <br /> W ❑ CONTAINMENT BARRIER(CB} ❑ ( ACTION REQUIRED ATM AT HOOKUP ® (VS) <br /> c 0 VACUUM EXTRACT(VE) OTHER(OTemOVed' to (i l gravel and �n;1 _ <br /> Analyses of the soil sample collected from soil and fill gravel excavated at the <br /> underground diesel fuel tank 827-D2U1 closure site showed ll.Omg/kg diesel fuel in <br /> soil. No diesel fuel was detected in the soil sample collected in the bottom of the <br /> if excavation. BTXE was not detected in either sample. <br /> HBc 05(&W <br />