Laserfiche WebLink
SAN JOAQUIN COUNTY <br />*ENVIRONMENTAL HEALTH DEPARTMENT fe <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orcl/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 cleanup the release from the primary containment <br />within 8 hours after the release was detected or should have been detected. nT F <br />AND <br />2. The release has not escaped the secondary containment. 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. 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. Date of release: <br />Operator's name: Phone Number: <br />3S�/. ��o.�a►C, <br />Facility name: s oeo /sz// y�$�/S/ Facility Address: cA <br />Hazardous substance found in the secondary containment: <br />Quantity: � ces Concentration: <br />Description of the actions taken to control and clean up the release: <br />The thod and locatioll of disposal of the releasqd hazardous substance: <br />.•a..l <br />Description of actions t en to repair the UST pnd to prevent future releases. Attach a co y of the <br />maintenance receipt:. �`1/,. , �••�s /,,,� c.►� ,�s�e <br />Describe hpw 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 />25294 for further requirements. <br />