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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT OW East Main Street, Stockton, CA 95202-3029 Telephone. (209) 46&3420 Fax. (209) 468-3433 Web. www.sjgov.ora/ehd i� i• r II i4 401111 ilgilgi • t 4 An owner or operator is required to record all releases from the primary containment, as approved in this faciiity's Response Plan. This form may be used to meet the recording requirements* if all of the conditions below are true. 1 The owner or operator can dean up the release from the primary containment within 8 hours after the release was detected or should have been detected. F AND 2. The release has not escaped the secondary containment.. �� L.'.1 F AND 3. The release does not increase the hazard of fire or explosion. k_Tj F AND 4. The reuse does not cause deterioration of the secondary containment. U F If all conditions above are not fulfilled you must E22ga the MWK to the San Joaquin County Environmental Health Department and other agencies as appropriate. Date of release: 'q Operator's name: V E=1� Z, a—.) Phone Number: It 717 - 7 2..41 - S% 7� Facility name: PU- �J bA- J ev'k -Z W -�q4dlity Address: 13 Y -Vu A% ;)c V Or'k:� /zi Hazardous substance found In the secondary containment: rZ.04.) 01 C- 0;:= Sv-L- Quantity: '%z- � Concentration: Description of the actions taken to control and clean up the release: The method and location of disposal of the released hazardous substance: Aj3"a�2 �5e� Description of actions taken to repair the UST and to prevent future releases. Attach a copy of the maintenance receipt: (.11:t t _ itt- -GYL v s C ae 0,,--i V aL OAK L*\ -n+ ar d na,i G. l n rza-c.. E Mt /? h- i -c t► . Describe how the monitoring system was reactivated after repairs or replacement: _ .`J' t N 50 iL t �i -Ncl� a etfi.-t�'i I i- F- a ^..,3 +<La,A-x,V vL', F4t. f ? r_0 a"j 0 t" —if -c- 4,C-167% 4 -Ll il4w",