Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 4683420 Fax: (209) 468-3433 Web: www.sigov.opq/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. a F <br />AND <br />3. The release does not increase the hazard of fire or explosion. LJ F <br />AND <br />4. The release does not cause deterioration of the secondary containment. O F <br />If all conditions above are not fulfilled you must reoort the release to the San Joaquin County <br />Environmental Health Department and other agencies as appropriate. <br />Operator's name: hy 1<,40 e ✓a4d l Phone Number: 7-&.. g - 4t S-1 Fl Fro <br />Facility name: Fla!, r_ � Cl�•eoepri Facility Address:_6ti y.1 Capp JaL 4yI-_ <br />Hazardous substance found in the secondary containment: rio»e _ <br />Quantity: Concentration: <br />Description of the actions taken to control and clean up the release: <br />__-- C'aLl a cQe-h PiTe"t+,'c," <br />The method and location of disposal of the released hazardous substance- <br />by <br />ubstance:hv the- 'Trar-- <br />Description of actions taken to repair the UST and to prevent future releases. Attach a copy of the <br />maintenance receipt:1414 <br />Describe how the monitoring system was reactivated after repairs or replacement: <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 />252.94 for further requirements_ <br />