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' UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE(LEAK)t CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES MR LOMAGEMAM O&T...: <br /> REPORT BEEN FLED Z <br /> YES [ NO ❑YES ® NO MEFEW CERTIFTINATl"AM:�t TEA ter:t HAVE <br /> naw 0 ?bT8�7 OF <br /> REPORT DATE <br /> 0►,e 3 Mi 1 d 8 <br /> NAME OF INDIVIDUAL FLING REPORT pHOIyE SIGNAAM <br /> CIA- C. Susi Jackson (510 ) 423-6577 ` <br /> a REPRESENTING ® OWNEIVOPERATOR ❑ REGIONAL APANY OR AGENCY NAME <br /> ❑12 <br /> LOCAL AGENCY ❑ OTHER University of California <br /> ADDRESS <br /> P.O. Box 808, L-633 7000 East Avenue Livermore CA 94550 <br /> STATE <br /> j fJAbIECONTACT PERSON PHONE <br /> Q Dennis K. Fisher ❑ UNIoam C. Susi Jackson (510)423-6577 <br /> a ADDRESS <br /> P.O. Box 808, L-668 7000 East Avenue Livermore CA 94550 <br /> sr>:Eer wTr STATE <br /> FACLJTY NAME(F OPERATOR PHO <br /> NE ap <br /> Lawrence Livermore National Laboratory <br /> Site 300 Building 827A Dennis K. Fisher (510)422-3343 <br /> ADDRESS <br /> Corral Hollow Road South of Trac San Joaquin County <br /> w CROSS STREET TYPE OF AREA F7 COMMERCIAL❑INDUSTRIAL® L am <br /> TYPE <br /> RURAearn <br /> ® RETA.FUELSTATION <br /> Es <br /> Interstate 580 ❑R ®OTHER Federal Lab ❑ FARM ® OTNER Research <br /> LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE <br /> San Joaquin County Public Health Services William Snavely (209)468-0336 <br /> REGIONAL BOARD PHONE <br /> a Central Valley RWQCB Susan T (916) 255-3057 <br /> (') NAME OUANTITY LOST(GALLOW <br /> W Diesel Fuel 10 71 UNKNom <br /> � (z) <br /> i DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROIL ® SUBSURFACE MONITORING ❑ NUISANCE CONINTIONs <br /> W <br /> Q u) 3 M' 1 0 10 9 v 4 v ❑ TANK TEST ® TANK AL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> wi 0 M 3 M 1 0 1 0 9 v 4 v ;AI UNKNOWN �e�t ® REMOVE F7 REPLACE TANK ® CLOW TAW <br /> p i HAS DISCHARGE BEEN STOPPED 4 ❑ REPAIR TMMCF7REPAIR PIPING CHANGE PROCEDURE <br /> o i <br /> YES ❑ No YES.DATE 0,,1 3 jI o) 1 01 9,1 4 v ❑ OTHER <br /> SOURCE OF DISCHARGE TANKS ONLYA:AFACITY MATERIAL CAUSE(S) <br /> TANK LEAK ❑ UNKNOWN 8000 GAL. ❑ FIBERGLASS ® OVERFILL ❑ RIPTUREIFALURE <br /> tit PIPING LEAK AGE 27 YRS STEEL ® CORROSION F7 U <br /> ❑ OTHER ❑ UNKNOWN ❑ OTHER ❑ SPILL Q OTHER <br /> iy CHECK ONE ONLY <br /> U ❑ UNDETERMINED SOL ONLY ❑ GROUNDWATER ❑ DRINKING WATER• (CHECK ONLY F WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> zC* <br /> 12 i ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS❑ SO4M OFF(CLEANUP COMPLETED OR UNNECESSARY) <br /> cU H; NO ACTKNI TAKEN ❑ POST CLEANUP MONITORING N PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES <br /> CHECK APPROPRIATE ACTION(S)(SEE BACs(FOR DETAU.S) <br /> ❑ CAP SITE(CO) ❑ EXCAVATE 6 DISPOSE(ED) ❑ RGUM FREE PRODUCT(FP) ❑ ENHANCED BID DEGRADATION(M <br /> ❑ CONTAINMENT BARRIER((E) ® EXCAVATE A TREAT(ET) ❑ PUMP A TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> ❑ TREATMENTATHOOKUP(HU) ❑ NO ACTION REOUIRED(NA) ® oTHER(oTt Remove tank & oyerexcayate <br /> i*When the tank was lifted from the closure excavation it released ten gallons of <br /> ?? i sludge through a corrosion hole. Impacted soil was excavated and sampled. <br /> 4*Also, sensory evidence suggested dispersed contaminati <br /> W on in the bottom of the <br /> excavation. Suspected impacted soil was excavated and sampled. Tank testing <br /> i had shown this tank to be leak tight. <br /> Hacm1�I <br />