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12:24 2093344684 04657 P.003 /003 <br /> W SAN JOAMAN CWNTY <br /> BmRommENTAL HEALTH DEPARTmENT <br /> 600 East Main Strai,4, Stockton, CA 95202-3029 <br /> Telephone.-(209) I <br /> 468-3420 Fax. (209)4M3433 Web:mW_sjgov—o-r9Lehd <br /> RECORDING REQUIREMENTS <br /> FOR UkAUTH :)RIZED RELEASES' <br /> An owner or operator is required � record all releases from the primary containment as approved in <br /> this facliftys Response Plan. This form may be used to meet the re=ding requiremeW if all of the <br /> conditions below are true. <br /> 1. The owner or operator I n clean up the release from the primary containment <br /> within 8 hours after the lease was detected or should have been detected. F <br /> AND UT <br /> 2. The release has not escaped the se ndary containment. F <br /> AND I <br /> 3. The released not increase the h azard of fire or explosion. T F <br /> AND <br /> 4. The release does not ca se deterior at'on of the secondary containment 8T F <br /> If all conditions above are not fulfillel you must-Boothe re to the San Joaquin County <br /> Environmental Health Department and other,tag tmcim as appropriate. Date of release* <br /> Operator's namO:--�U I r6kf- P0. Phone Number. '9 LA. ,7 ti <br /> Facilityname: C) <br /> Facility Add rew: ZZ(o n A-xm <br /> Hazardous substance found in the secondary mritainment- <br /> Quantity,: ' Concentnition: <br /> �L I <br /> -Description of the actions taken to control and can up the release: <br /> The method and locafion�of Idis of the released hazardous substance* <br /> _ posa ,, <br /> Ina-Z: wwv� 6E�_ <br /> Description of actions taken to repalthe UST a id to prove future releases. Attach a copy of the <br /> mainteria Weipt.- (, fA%k I V <br /> 2K <br /> Describe how the monitoring syste was read hrated after repairs or replacement- <br /> Aftach printout from continuous monitoring system, intenanee receipts,manifests, photos, etc. <br /> Retain this document with your monftori rds for review during the annual inspection by our departmerit <br /> *See the Caldomia Code of Regulations Title 23,So%on 2651 and Califbmia Health&Safety Code Section <br /> 25294 for furdier requirements. <br />