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r r • SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.slgov.org/ehd <br /> RECORDING REQUIREMENTS <br /> FOR UNAUTHORIZED RELEASES <br /> An owner or operator is required to record all releases from the primary containment, as approved in <br /> this facility's Response Plan. This form may be used to meet the recording requirements* if all of the <br /> conditions below are true. <br /> 1. The owner or operator can clean up the release from the primary containment <br /> within 8 hours after the release was detected or should have been detected. © F <br /> AND <br /> 2. The release has not escaped the secondary containment. TQ F <br /> AND � <br /> 3. The release does not increase the hazard of fire or explosion. l:/ F <br /> AND <br /> 4. The release does not cause deterioration of the secondary containment. Q F <br /> If all conditions above are not fulfilled you must report the release to the San Joaquin County <br /> Environmental Health Department and other agencies as appropriate. <br /> Operator's name: Pat Farrington (on behalf of Raley's) Phone Number: (916) 376-6697 <br /> Facility name: Raley's Aisle 1, 9356 Facility Address: 4219 Morada Ln., Stockton 95212 <br /> Hazardous substance found in the secondary containment: Mostly Water mixture <br /> Quantity: Minimal < 1 gallon Concentration: Water with some fuel <br /> Description of the actions taken to control and clean up the release: Service Station Systems <br /> removed the fluid with Absorbent rays and placed them in the Hazardous Waste Drums onsite. <br /> The method and location of disposal of the released hazardous substance: Absorbent rays used <br /> to clean uy fluid were placed into the hazardous waste drums located in the locked trash enclosure <br /> at this fuel site. <br /> Description of actions taken to repair the UST and to prevent future releases. Attach a copy of the <br /> maintenance receipt: Service Station Systems removed the liquid and then reviewed the areas to <br /> assure that no leakage was occurring. <br /> Describe how the monitoring system was reactivated after repairs or replacement: The monitoring <br /> system was not activated due to the low levels of fluid in the secondary containment (did not <br /> trigger and alarm). <br /> Attach printout from continuous monitoring system, maintenance receipts, manifests, photos,etc. <br /> Retain this document with your monitoring records for review during the annual inspection by our department. <br /> *See the California Code of Regulations. Title 23, Section 2651 and California Health & Safety Code Section <br /> 25294 for further requirements. <br />