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Underground Storage Tank System <br />Required by Section 2651 CCR, and 25294 HSC <br />Facility Name: Operator Name: <br />Site Address: Operator Phone: <br />Date / Time of Reported To And Date / Time Type and Quantity of Hazardous Corrective Action Taken To Control and Clean up Disposal Location / <br />Discovery Reported By Reported Substance Released Release and Repair Manifest # <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />To: <br />Type: <br />By: <br />Quantity: <br />[Revised 8/ 1/01 GKIn Monitoring Report Release Log <br />E <br />