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RECORDING REQUIREMENTS <br />FORUNAUTHORIZED RELEASES <br />An owner or operator is required to record all releases from the primary containment. This form may be <br />used to meet the recording requirements. (Please notify Tulare County Environmental Health <br />immediately if- 1). The owner or operator can not clean up the release within 8 hours after the release <br />was detected or should have been detected, 2). The release has escaped secondary containment, 3). The <br />release increases the hazard of fire or explosion, and/or4). Will cause deterioration of the secondary <br />containment). <br />Reporting party's name and phone number: &114 ` <br />Facility name and address:y� �� acil-e- �, <br />Date and time: (v Z A2 `14— <br />Type of material found in the secondary containment: <br />Quality: Concentration; <br />What actions were*taken.to control and clean up the release: QA U_r1 <br />11-t i�d r, _ . i- . - - - <br />Method and location of disposal of released material: 15 qw <br />{ &v <br />u� Liray o 7�p pSo % �2A e. t� c�y e-c� c� T <br />% <br />Description of actions <br />t(.- <br />actions ta�kye�n to re-pa^ir the underground storage tank and prevent future releases: <br />How was the monitoring system reactivated after corrections were made: <br />e -0;-/G r <br />Attach print out from continuous monitoring system, maintenance reports, and/or manifests etc. <br />Retain this document in monitoring records for inspection by Tulare County Environmental Health. <br />See California Code of Regulations Section 2651 for further requirements. <br />PAGE 2 OF 2 <br />