COMPLIANCE INFO_FILE 8 - Laserfiche WebLink

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UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT EMERGENCY HAS STATE OFFICE OF EMERGENCYSERVICES .. ❑ YES NO REPORT BEEN FILED T DYES © NO 1.K...0,`I.GERTIFY THAT i AM A DE3IGNA EO CaQ11 i f M.GYFE'AND THAT:i HAVE REPT)RTED;:THIS:NFORMAPON:>TO..#:OCAL ORIC.> .PIMA�T..TO:.SECTI011t:.251. 7 REPORT DATE CASEii tHE#IEALTH, SAE?Y p MAL 0 M 3 M 1 ,1 8 D 9 Y 4 Y SN3NED i ..:; :..:i .::. ::(. .: :i TE.:i NAME OF INDIVIDUAL FILING REPORT PHONE SIGN_A Y C. Susi Jackson (510 ) 423-6577 m w REPRESENTING ® OWNERlOPERATOR ❑ REGIONAL BOARD COMPANY OR AGENCY NAME ❑ LOCAL AGENCY ❑ OTHER University of California 0 2 ADDRESS P.O. Box 808, L-633 7000 East Avenue Livermore CA 94550 STREET CITY STATE ZIP Lq NAME CONTACT PERSON PHONE zQ Dennis K. Fisher ❑ UNKNOWN C. Susi Jackson (510)423-6577 R a ADDRESS Q P.O. Box 808, L-668 7000 East Avenue Livermore CA 94550 STREET CRY STATE ZIP FACILITY NAME(IF APPLICABLE) OPERATOR PHONE Lawrence Livermore National Laboratory 4 Site 300 Building 827A Dennis K. Fisher 1 (510)422-3343 ADDRESS Corral Hollow Road South of Tracy San Joaquin County STREET TTY COUNTY ZIP y CROSS STREET TYPE OF AREA ❑COMMERCIAL ❑INDUSTRIAL❑RURAL TYPE OF BUSINESS ❑ RETAIL FUEL STATION Interstate 580 [—]RESIDENTIAL ©OTHER Federal Lab ❑ FARM [K] OTHER Research LOCAL AGENCY AGENCY NAME CONTACT PERSON PHONE San Joaquin County Public Health Services William Snavely (209 )468-0336 W 2 W w REGIONAL BOARD PHONE C` Central Valley RWQCB Susan Timm (916 ) 255-3057 rn (1) NAME QUANTITY LOST(GALLONS) OW Diesel Fuel 10 ❑ UNKNOWN 2 (2) W ❑ UNKNOWN Z DATE DISCOVERED HOW DISCOVERED ❑ INVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS O M 3 M l D l D 9 Y 4 y E] TANK TEST ® TANK REMOVAL ❑ OTHER DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) w 0 ml 3 .1 1 .1 1 .1 9 yj 4 y © UNKNOWN ** ® REMOVE CONTENTS ❑ REPLACE TANK ® CLOSE TANK HAS DISCHARGE BEEN STOPPED 7 ❑ REPAIR TANK ❑ REPAIR PIPING ❑ CHANGE PROCEDURE p [:RYES ❑ NO IF YES,DATE Oml 3 ml IDI 1 D 9yj 4 Y ❑ OTHER W SOURCE OF DISCHARGE TANKS ONLY/CAPACITY MATERIAL CAUSE(S) 0 TANK LEAK ❑ UNKNOWN BOOO GAL. ❑ FIBERGLASS ❑ OVERFILL ❑ RUPTURE/FAILURE U� ❑ PIPING LEAK AGE 27 YRS STEEL ® CORROSION ❑ UNKNOWN ❑ OTHER ❑ UNKNOWN ❑ OTHER ❑ SPILL ❑ OTHER WW CHECK ONE ONLY a v ❑ UNDETERMINED ® SOIL ONLY ❑ GROUNDWATER ❑ DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) CHECK ONE ONLY Lu a ❑ SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) ❑ CLEANUP IN PROGRESS ❑ SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) cc v N NO ACTION TAKEN ❑ POST CLEANUP MONITORING IN PROGRESS ❑ NO FUNDS AVAILABLE TO PROCEED ❑ EVALUATING CLEANUP ALTERNATIVES CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) E5 O ❑ CAP SITE(CD) ❑ EXCAVATE&DISPOSE(ED) ❑ REMOVE FREE PRODUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) ❑ CONTAINMENT BARRIER(CB) ❑ EXCAVATE&TREAT(ET) ❑ PUMP&TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) ❑ TREATMENT ATHOOKUP(HU) ❑ NO ACTION REQUIRED(NA) ® OTHER(OT) Remove tank & overexcavate *When the tank was lifted from the closure excavation it released ten gallons of P sludge through a corrosion hole. Impacted soil was excavated and sampled. *Also, sensory evidence suggested dispersed contamination in the bottom of the excavation. Suspected impacted soil was excavated and sampled. Tank testing had shown this tank to be leak tight. HSC 05(4197)