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0 SAN <br />JOAQUIN COUNTY <br />EwRoNmEmTALDEPARTMENT <br />• # '# East Main Street• •, <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 thz <br />conditions below are true. <br />I - 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. F <br />2. The release has not escaped the secondary containment F <br />AND <br />3. The release does not increase the hazard of fire or explosion. F <br />AND <br />4. The release does not cause deterioration of the secondary containment F <br />If all conditions above are not:• you must reDort: • the San Joaquin County <br />Environmental Health Department and other agencies as appropriate. Date of release: <br />Facility name: CCL--r� 4Wt�, �s-- Facirity ' • l <br />,. <br />Hazardous substance found in the secondary containment T>j SA% !E: L, -F0 kA_,, <br />Quantity: <br />• • • t•- e•,,I • • « • - <br />The method and location of disposal of the released hazardous substance: <br />z .,• <br />Description of actions taken to repair the UST and to prevent future releases. Attach a copy of the <br />maintenance - • <br />Sescribe how the rPrT' <br />Y'�.•--- <br />A tach printout frons continuous monitoring system, maintenance receipts, mariffests, 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, ride 23, Section 2651 and California Health & Safety Code Section <br />25294 for further requirements. <br />