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2018-11-20 13:23 Sunwest Chevron 2758 >> 2044683433 P 1/1 <br /> SAN JOAQUIN COUNTY <br /> 15NVIRONMENTAL HEALTH DEPARTMENT <br /> 1$68 E. Hazelton Ave., Stockton, CA 95205-6232 ' � �9;— <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.or, /q ehd <br /> RECORDING REQUIREMENTS /V0 V 2 p 2018 <br /> FOR UNAUTHORIZED RELEASES r�.. T'' <br /> An owner or operator is required to record all releases from the primary containment, as approved in T <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 /> I- 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. T F <br /> AND <br /> 2. The release has not escaped the secondary containment. T F <br /> AND <br /> 3. The release does not increase the hazard of fire or explosion. T F <br /> AND <br /> 4. The release does not cause deterioration of the secondary containment. T 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: 1W � <br /> Operator's name. Phone Number:(9 )to - 41 1 <br /> Facility name:S`U-v1W1P--Ar #%rb,n __ Facility Address: 2 7 56 W t. 46vb"N <br /> Hazardous substance found in the secondary containment: <br /> quantity: _ess -� c,\4N) Concentration: `� CT,,,,,Q, C�,s <br /> a <br /> Description of the actions taken to control and clean u the releas <br /> �` a� vocccC> <br /> The method and location of disposal of the released hazardous substance: �\Ctz-,�kAo UA <br /> Description of actions taken to repair the UST CVd to prevent future releases. Attach a copy of the <br /> maintenance receipt: 1-i� l 1�. —Keg V ca-1 ^� <br /> Describe how the monitoring s s (fn was reactivated pfter repairs or replaceme t: <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 Caiifomia Health&Safety Code Section <br /> 25294 for further requirements. <br />