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UCRL-AR-103194 <br /> Operator's Monitoring Record for <br /> Unauthorized Release* <br /> Submit to WATS Group (L-633) of the EPD within five working <br /> days after detection of release <br /> Name: Telephone: <br /> Tank No: Piping leak? Tank leak? <br /> Type of hazardous substance: <br /> Concentration of substance: Quantity released: <br /> Date and time release discovered: <br /> Date and time release cleanup completed: <br /> Cleanup method: <br /> Disposal method: <br /> Disposal location (attach a copy of the manifest,if used): <br /> Tank repaired? <br /> Any changes to the tank system? <br /> Monitor reactivated or new monitor installed? <br /> How is the annular space currently monitored? <br /> Future leak prevention method: <br /> Approximate cleanup cost(optional): <br /> *Use this form if a primary piping leak or a primary tank leak occurs,and all conditions of <br /> recordable release are met. <br /> Call WAIS Group for additional forms(423-7417) <br /> E-2 Monitoring Program for New Underground Storage Tank <br />