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0 <br /> RECEIVED <br /> SAN JOAQUIN COUNTY <br /> RECEIVEIIIENVIRONIVIENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> JUL 1 OrjaWhone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sigov.org/ehdlUL 2 13 <br /> SANJOAQUIN COUNTY RECORDING REQUIREMENTS ENVIRONMENTAL �NVOAQUINCOU1y <br /> HEALTH DEPARTMENT FOR UNAUTHORIZED RELEASES HEALTHDEPARTMENT <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 clean up the release from the primary containment � <br /> within 8 hours after the release was detected or should have been detected. L'1 F <br /> AND � <br /> 2. The release has not escaped the secondary containment. L'J 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: 5123/2013 <br /> Operator's name: Jivtesh S. Gill Phone Number. 209-939-0679 <br /> Facility name: 7-Eleven Inc 432190 Facility Address: 4943 S. STATE RT. 99 <br /> Hazardous substance found in the secondary containment. Gasoline and water <br /> Quantity: — I liter Concentration: 50% <br /> Description of the actions taken to control and clean up the release: _Liquid was immediately <br /> removed by testing contractor <br /> The method and location of disposal of the released hazardous substance: Liquid was placed in <br /> appropriate receptacle on site and will be hauled off as waste. <br /> Description of actions taken to repair the UST and to prevent future releases. Attach a copy of the <br /> maintenance receipt: During the inspection there was no evidence of an active release. Walton <br /> Engineering conducted a piping test and confirmed the product piping to be tight, investigation to <br /> continuing. <br /> Describe how the monitoring system was reactivated after repairs or replacement: <br /> NIA <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 />