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UNDERGROUND AGE TANK UNAUTHORIZED RELEASE(LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES FOR LOCA 'A E CY USE ONLY <br /> REPORT BEEN FILED? <br /> YES Dn NO ❑ YES ❑ NO I HEREBY CERTIFYTHATT HAVE DISTRIBUTED THIS INFORMATION ACCORDING TO THE: <br /> <:DISTRIBUTION SHOWN ON THE INSTRUCTION SH . ;ON THE BACK PA OFTHIS FOR <br /> REPORT DATE CASE x <br /> 1 M O M 2 7 9 4 r SGNED DATE <br /> .::-- <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SI R <br /> C. Susi Jackson 1 (510 ) 423-6577 <br /> W REPRESENTING ® OWNER/OPERATOR E-1REGIONAL BOARD COMPANY OR AGENCY NAME <br /> 2 LOCALAGENCY a OTHER University of California <br /> Cc ADDRESS <br /> P.O. Box 808, L-633 STREET 7000 East Ave. omLivermore STATE CA z(94550 <br /> W NAME CONTACTPERSON PHONE <br /> J <br /> ZDennis K. Fisher ❑ UNKNOWN C. Susi Jackson (510 ) 423-6577 <br /> Oaa ADDRESS <br /> (A 0. <br /> W <br /> cc P.O. Box 808 L-668 STREET 7000 East Ave. Cm Livermore STATE CA z94550 <br /> FACILITY NAME(IF APPLICABLE) OPERATOR PHONE <br /> Lawrence Livermore National Laboratory <br /> o Site u' Dennis K. Fisher (510 ) 422-3343 <br /> q ADDRESS <br /> U <br /> Corral Hollow Road STREET CrTrSouth of Trac <br /> W <br /> oouHTStan Joa u]zA <br /> CROSS STREET <br /> Interstate 580 <br /> O LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> Z U San Joaquin County Public Health Services William Snavely X09 }468-0336 <br /> W w REGIONAL BOARD PHONE <br /> 2 4 Central Valley RW CB Susan Timm 916 }255-3057 <br /> y (1) NAME QUANTITY LOST(GALLONS) <br /> OW <br /> J Diesel Fuel UNKNOWN <br /> Z (Z) <br /> U I UNKNOWN <br /> z DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING NUISANCE CONDITIONS <br /> W 1 Ml OMI 2 ml 0 pl 9 v 4 v ❑ TANK TEST ® TANK REMOVAL ® OTHER Diesel Fuel Smell in soil. <br /> e- <br /> a DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> m <br /> Q <br /> ® UNKNOWN ❑REMOVE CONTENTS ®CLOSE TANK&REMOVE ❑REPAIR PIPING <br /> W M .1 DI YJ v <br /> O HAS DISCHARGE BEEN STOPPED? ❑REPAIR TANK CLOSE TANK&FILL IN PLACE [::]CHANGE PROCEDURE <br /> Cn ® YES a NO IF YES,DATE M <br /> UNKNOWN D v v a REPLACE TANK a OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ccf)a ❑ TANK LEAK ❑ UNKNOWN ® OVERFILL ❑ RUPTURE/FAILURE ❑ SPILL <br /> � <br /> O ❑ PIPING LEAK ® OTHER E] CORROSION a UNKNOWN OTHER <br /> WW CHECK ONE ONLY <br /> O ❑ UNDETERMINED ® SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER -(CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> W <br /> 9) ® NO ACTION TAKEN F-] PRELIMINARYSITE ASSESSMENT WORKPLAN SUBMITTED ❑ POLLUTION CHARACTERIZATION <br /> � <br /> ;� ❑ LEAK BEING CONFIRMED ❑ PRELIMINARY SITE ASSESSMENT UNDERWAY F--] POST CLEANUP MONITORING IN PROGRESS <br /> U ❑ REMEDIATION PLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTION(S) ❑ EXCAVATE&DISPOSE'ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> J (SEE 9Aca FOR DETAkSI <br /> a00 Z ❑ CAP SITE(CD) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) <br /> W cQ~s ❑ CONTAINMENT BARRIER(CB) NO ACTION REQUIRED(NA) ❑ TREATMENT AT HOOKUP(HU) ❑ VENT SOIL(VS) <br /> ❑ <br /> VACUUM EXTRACT(VE) ® OTHER(OT) Remove tank. Overexcavate as indicated by William Sna ely <br /> and Me resuits ol soil sample analyses. <br /> z <br /> LU <br /> The tank and some contaminated fill have been removed. We will bore holes through the <br /> vunderlying concrete slab and collect and analyse soil samples to determine if removal <br /> of the slab and additional soil is needed. <br /> HSC 05(8/9% <br /> l <br />