Laserfiche WebLink
SAN JOAQUIN COUNTY SEI" O 7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton, CA 952023029 SAN JOAQUIN COUNTY <br /> telephone;(209)468-3420 Fax:(209)469-3433 Web:www.rigov.org/ehd ENVIRONMENTAL <br /> RECORDING REQUIREMENTS HEALTH DEPARTMENT <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 cleanup 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. T F <br /> AND <br /> 3. The release does not increase the hazard of fire or explosion. F <br /> AND <br /> 4. The release does not cause deterioration of the secondary containment. TO F <br /> if all conditions above are not fulfilled you must report the release to the San Joaquin County f <br /> Environmental Health Department and <br /> �,other agencies as appropriate. Date of release:, A <br /> Operator's name:� ��� '�PppIE�' "�mPhoneNumber: 5�1' —&e0bn -, <br /> Facility name: (,t'ltifS���i 1 v(,r�Yt,�Cl 1�74 Facility Address) <br /> Hazardous substance found In the secondary containment; <br /> Quantity: wV Concentration: <br /> Description of the actions taken to control and clean ul the release: <br /> �g <br /> The e�thh d.�anndd locationofdisposal of the releas d hazar ous t n e: <br /> l A <br /> Description of actions an to re air the UST and to preVent future releases, Attac co gy of the <br /> maintenanc receipt; Gl \ -� <br /> Describe ow the monitorin syste w reactivated after repairs or replacement: <br /> Attach printout from continuous monitoring system,maintenance receipts,manifests, photo$,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 2851 and California Health&Safety Code Section <br /> 25294 for further requirements. <br /> I <br /> i <br />