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^- Dec 22 14 07:06a Mid Valley Consulting 530-749-9892 p,2 <br /> Dec 111e07:48z Mid'dalley(V6suiting - <br /> 530 7495892 P. <br /> RECEIVE <br /> SAN JOAgllIN COUNTY <br /> ENVIRONMENTAL HEAL-14 DEPARTMENT ?"r <br /> D E C 2 ?- 20141858 E. Hazelton Ave.,Stockton, CA 95205-6232 I <br /> Telephone:(209) 468-3420 Fax:(209)468-3433 Web:www siaov orgiehtl <br /> ENMRONMENTA.LHEALTH RECORDING REQUIREMENTS <br /> DEPARTMENT FOR UNAUTHORIZED RELEASESW <br /> An owner o-operator is required to record all releases from the primary containment, as approved in <br /> this facility's Response lotar. This form may be used to meet the recording nequiremente if all of the <br /> conditions below are true. <br /> 1- The owner or operator can Gear up the release from the <br /> within 8 hours after the release was detected or should have beermary teed nt F <br /> AND �G <br /> AND <br /> 2. The release has not escaped the secondary containment. 1 F <br /> 3, The release does not inc-ease the hazard of fi-e or explosion, fff��� <br /> AND F <br /> 4. The release does not cause deteroration of the secondary containment. <br /> T F <br /> If all condhions above are not fulfified you mull <br /> 'ecort the release to the San Joaquin Coun -- <br /> En'oronmental Health Department and other agencies as appropriate. Date of release: [tv li' '- <br /> Operator's name: v` <br /> _ rU mp nx a / Phone Number�Cl <br /> Facility name:ll1 4 l R,t o r eh f[1 <br /> Facility Address: <br /> Hazardous substance found in the secondary containment: £ S f rw <br /> Quantity: Concentration:_ �4417 <br /> Description of Ina act' taken to control pd clean u th reuse: <br /> �Cl!? 'r� <br /> o�l0ac p'—_s_��eta <br /> -�` <br /> T meth d Iocation of disposal of the n:leased hazardous substance: <br /> ��» 5 e� r, <br /> Description of actions tales to repair T and to pre nt future releases. Attach Loopy of the <br /> main'enan eceipt (� <br /> t I2 —� E /Y 2t e tcTsi✓� <br /> Describe how the mondoring system was reactivated er e <br /> —�0 ( CC" « e=or or replacement: <br /> Attach printout from con mous monitorng system,maintenance receipts,manifests, photos,e[e. <br /> Retain this documenwi6 <br /> t r your monitoring records for review during the annual inspection s.our department <br /> 'See th=-CalifcMa Code of Regulations,Title 23, Section 2651 and Cal�'fornia Health&Safety Code Section <br /> 26294 for further requ-cements. <br />