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10/06/2011 08:10 2099316743 waterloo Food Mart #0720 P.009/015
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<br />L-NDERGROUND STORAGE TANK
<br />RLI9PONSIC )FLAN — PAGIl 2
<br />VT. RIJPORTRiG APiD RECORD I1XEPD G
<br />Vr'a ;11 , or�.,,c',....,,.1 y ,,,.., rn, eP aL o. ,.,wuttwrizcd ml« firm o UST ayatuu as indioaeod in +u pr'—
<br />Recordable Releases: Any unauthorized release from primary containment which the UST operator is able to clam up within eight (8) boats after the ralcase was
<br />detected or sbould reasonably have been detected, and which does not escape from secondary containment, docs not increase the hazard of fire or explosion, and does
<br />not cause any deterioration of secondary contaimnent, must be recorded in the facility's monitoring records. Monitoring roeords Must include:
<br />➢ The UST operator's name and telephone number;
<br />i A list of the types, quaQtities, and concentrations of hazardous substances released;
<br />i A description of the actions inked to control and clan up the release;
<br />i The method and location of disposal of the released hazardous subsmccs, and whether a hazardous waste manifest was or will be used;
<br />Y A description of actions taken to repair the UST and to prevent ftdtre releases;
<br />Y A description of the method used to reactivate IIrtcrsiitial monitordgb atter replacement or repair of pri nary containnaut"
<br />Reportable Releases: Any overfill, spill. or unauthork ed release which escapes from secondary" containment (or primary contafimic11t if no secondary containment
<br />exists), increases the hazard of fire or explosion, Or causes any deterioration of secondary containment, is a reportable release. Reportable releases are also recordable.
<br />Within 24 hours after a reportable release has been dexccwd, or should have been detected, we will notify the local agency administering the UST program of the
<br />release, investigate the release. and take immediate measures to stop the release. if necessary, or if required by the local agency, remaining spored product/waste will
<br />be removed from the UST to prevent further releases or facilitate cotrective action_ I£an emergency exists, we will notify the State Office of Emcrgcncy Services.
<br />Witbitt five (5) worsting days of a reportable release, we will submit to the local agency a full written report containing all of the following information to the extent
<br />that the infontiation is known at the time of filing the report:
<br />5 The UST owner's or operator's name and telephone nurnbm
<br />A list of the types, quantities, and concentrations of hazardous materials rcirascd;
<br />)�, Tbc approximate date of the release;
<br />➢ The date on which the release was discovered,
<br />➢ Tbc date on which the release was stopped;
<br />➢ A description of actions taken to control and/or stop the release;
<br />i A description of corrective and remedial actions, including investigations which were undertaken and will be conducted to determine the nature and extent of
<br />soil, ground water or surface water contamination due to the releaser
<br />> The tnethod(s) of cleanup implemented to date, proposed cleanup actions, and a scbedulc for implementing the proposed actions.
<br />➢ The method(s) and location(s) of disposal of released hazardous materials and any contaminated soils, grounedwau r, or surface water_
<br />i% Copies of any ha'Grdous waste manifmts used for off-site transport of hazardous wastes associated with clear-up activity;
<br />9 A description of proposed r acttods for any repair or replacement of UST system primary/secondary containincut systems;
<br />9 A description of additional actiotas taken to prevent future releases.
<br />We will follow the reporting procedures descnbed above if any of the following conditions occur:
<br />A recordable unauthorized release can not be cleaned up or is still under investigation within right (3) hours of detection;
<br />Released hazardous substances are discovered at the UST site or in the surrounding area;
<br />i 1 Tmmial rnvT tine rrxviitinm err nhvorvoer inrhvii*g or, -at;, i..ho. of r..- A—t A.r .4,a , ,aha.. t— ,s r, +. e. a � ry y.r�_a .. og
<br />D Mvnitorhlz rr3ulr5 from UST SYStern Ax iitvtirre taruirnnueVinrth x1% irdicmte thml a rot -.en: nrny have rrnrrrefl, rminae rho mnnimehms .br,:t,rn.v.t iv ?Hard to bo
<br />defective and is mune diatphy rLyei v& trcaltbatted. or replaced, and additional monitoring dclec w)t ccmfrrm the initial nmsurltc
<br />Record Retortion: Momtoring records and written reports of unauthorized releases must be maintained on-site (or off-site n a readily avaiilable location, if approved
<br />by the local agency) for at least 3 years. Hazardous waste shippbig/disposal records (e.g., manifests) must be maintained for at least 3 years from the date of shipment_
<br />VII. OWNER/OPERATOR SIGNATURE
<br />CERTIFICATION: I certify that the inforinxtiou provided herein is true and accurate to the best of my knowledge.
<br />OWNER/OPERATORSIGNATURE
<br />DATE
<br />OWNMOPERATORN2AME(pact)`1n xe1.
<br />OWPtEii/OP RT'=
<br />5 Aqe
<br />(Agency Use Only) This Ulm has �evnew and- ❑ Argmnve-d With rnnditieme Q � �oFF r—qd
<br />1 -tical Agency Signarnre
<br />UN -#22B - 10 www.anidocs.org Rev_ Aaht.mx
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