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Un0cmaells <br />a <br />6if <br />01:40 <br />t •, :10012061A 0 r <br />S/S #: Business Name: <br />Address: <br />Tank #: Capacity. <br />prnri��nt- <br />TO BE COMPLETED BY THE DEALER <br />Dote leak was discovered: <br />Approximate date leak began: <br />Describe fully the cause of the leak: <br />How was the leak discovered? <br />rO BE COMPLETED BY THE UNOCAL RETAIL REPRESENTATIVE <br />9 <br />Complete this form <br />in the event of a <br />confirmed look or <br />spill and send to <br />your Unocal rep. <br />within 24 hours. <br />Has <br />the <br />leak <br />been <br />stopped? Date: <br />#� How <br />I <br />was <br />the <br />leak <br />stopped? <br />'moi t1192urces affected: Lu -NA ThreQjgned l of wells <br />Soil <br />Creek or Storm drains _ <br />Buildings or Utility Vaults,, <br />Groundwater _ <br />Public Drinking Water _ <br />Private Drinking Water <br />Agricultural <br />Other <br />Instructions to Unocoi Retail Re�,gtxn,atives: <br />This form must be forwarded to Unocal Maintenance do Construction Department <br />IMMEDIATELY so they can submit to the appropriate local agency within 5 days of <br />discovery of any leak. <br />