Laserfiche WebLink
Fle I:D. <br /> LUSTIS <br /> Leakin Under round Fuel Tank Data Collection Checklist Local Agency FN <br /> RWQCB <br /> SITE: 1�� <br /> ADDRESS: 7 oo <br /> CITY: �foC V`' COUNTY: -y-" 00 C-444" REG.BOARD No: <br /> REVIEWED BY: _I r�iP�/� /(�N � --- I HSI P-0L ,0,/�) DATE:_L/S-/5f' <br /> (Name) (Agency) <br /> I. RELEASE INFORMATION(FROM TECHNICAL REPORTS OR OTHER FILE DOCUMENTS) <br /> a) Check(X]type of product(s)which leaked: ® Gesolfne Diesel <br /> ❑ OUW <br /> b) Was source of leak identified? YES NO <br /> If YES,check Pq source location(s): <br /> ❑ Tank ❑ Piping ❑ overfill <br /> ❑ Other <br /> c) Was rate of release estimated? YES ONO <br /> If YES,specify rate: <br /> d) Was mass/volume of release estimated? YES l NO <br /> If YES,specify masslvolume(note unit of measurement): <br /> e) Was tank removed? NO <br /> If YES,specify: <br /> COMMENTS: <br /> H. SITE INVESTIGATION INFORMATION(FROM REPORTS OR OTW RLE DOCUMENTS) <br /> a) Was"free product'reported? YES NO <br /> If YES,check(X]location(s)where free product was noted: <br /> Excavation ❑ Soil Sample <br /> ❑ Monitoring Well <br /> If MONITORING WELL,specify maximum thickness reported (note unit of measurement): <br /> b) Was a soil vapor survey conducted? YES 3 <br /> c) Was an aquifer test(e.g.,pumping or slug test) performed? ES� NO <br /> d) Number of monitoring wells installed at the site 0 <br /> e) Number of soil (or'Hydropunch") borings NOT completed as welfic <br /> COMMENTS: <br />