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Amok Ah <br /> UNDERGROUND STORAGE K UNAUTHORIZED RELEASE (LEAK)/ ONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR 'AGENCYUSE ONLY <br /> REPORT BEEN FILED Z® ❑YES 0•� ® � 1HEREBYCERM7NAT:F:HAVE DISTRSgTEDTHISWORAIATiON TOTNE <br /> DISTRBUTIxN"SHOWNON:THE INSIRUCTIDN SHEETON7HE BACK PAGE OFTHIS FORM <br /> REPORT DATE CASES <br /> 7 ml 1 d 109 4 v SIGNED DATE <br /> NAME OF INDIVIDUAL FLING REPORT PHONE SIGN <br /> ® C. Susi Jackson (510 ) 423-6577 <br /> REPRESENTING ® OWNERIOPERATOR Q REGIONAL BOARD COMPANY OR AGENCY NAME <br /> Q Q LOCAL AGENCY ❑ OTHER University of California <br /> ADDRESS <br /> P.O. Box 808, L-633 7000 East Ave. Livermore CA 94550 <br /> sTR¢Er Cm STATE ZIP <br /> J NAME CONTACTPERSON PHONE <br /> 1� Dennis K. Fisher ❑UNKNOWN C. Susi Jackson (510 )423-6577 <br /> 9 a ADDRESS <br /> P.O. Box 808, L-668 7000 East Ave. Livermore Ca. 94550 <br /> CT' STATE o <br /> FACKITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Lawrence Livermore National Laboratory <br /> Site 300, Building Dennis K. Fisher (510 )422-3343 <br /> .` ADDRESS <br /> Corral Hollow Road South of Trace San Joaquin <br /> �y STREET C" San <br /> a-i CROSS STREET <br /> Interstate 580 <br /> * LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> w Lu San Joaquin Count Public Health Servic s William Snavely (20 ) 468-D331 <br /> REGIONAL BOARD <br /> PHONE <br /> a Central Valley RWQCB Susan Timm (916 ) 255-3057 <br /> w (') NAME <br /> ® OUANTTTY LOST(GALLONS) <br /> > Diesel Fuel [] UNKNOWN <br /> ® UNKNOWN <br /> W <br /> DATEDISCOVERED HOW DISCOVERED ED IN CONTROL ❑ SUBSURFACE MONITORING ED NUISANCE CONDITIONS <br /> 2 ® J O 1 D� 9 4 r TANK TEST TANK REMOVAL OTHER <br /> ❑ ® R@View Soil amDle Analyses. <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> >$ M o v) r ❑ UNKNOWN ❑REMOVE CONTENTS ❑CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> $ HAS DISCHARGE BEEN STOPPED T F-1REPAIR TANK ❑CLOSE TANK&FILL IN PLACE ❑CHANGE PROCEDURE <br /> ® YES ❑ NO F YES.DATE 0.! 6 j 2 D! 2 d 9 vI 4 v ❑REPLACE TANK ❑OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ❑ TANK LEAK ❑ UNKNOWN to OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> ❑ PIPING LEAK ® OTHER ❑ CORROSION O 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 /> ® NO ACTION TAKEN ❑ PRELBAMARY SITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> ® LEAK BEING CONFIRMED a PRELIMINARY SITE ASSESSMENT UNDERWAY O POST CLEANUP MONITORING IN PROGRESS <br /> ❑ REMEDIATXMN PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) Q CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTIOV(S) ❑ EXCAVATE&DISPOSE(ED) ® REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIO DEGRADATION(IT) <br /> t+atracRsoaeTAul <br /> ❑ CAP SITE(CO) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT)❑ REPLACE SUPPLY(RS) <br /> ❑ CONTAINMENT BARRIER(CB) ❑ NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ❑ <br /> VACUUM EXTRACT(VE) ® OTHER(OT)_Remnve d tank- fill - rnnrrptp s l ah- and soil - <br /> The <br /> oile analyses of the soil sample collected from soil and fill gravel excavated at the <br /> g underground diesel fuel tank 805-DIU1 closure site showed 7.4 mg/kg diesel fuel in the <br /> oil. No diesel fuel was detected in the soil sample collected in the bottom of the <br /> excavation. BTXE was not detected in either sample. <br /> roc�lagv, <br />