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08/26/2010 11:13 2093344684 #2974 P.002 /002 <br />^UV v.s IV I I .v Iia -*LAML-144-Ul It5 p.1 <br />SAN JOAQUIN COtWff <br />ENVN=MENTAL HEALTH [EP ENT <br />900 East Main Street, Stockton, GA 95202-3029 <br />Telephone-* (209) 465-3420 Fax. (209) 458-3433 Web. _Www.siCovorWehd <br />141*1111991W i <br /># , z It <br />An Ownerr Ope-MOr is required to record all releases 'from the primmy containment, jar, approved 1r) <br />tNs lacility's Response Plam This Ibrm may be used to meet the recording requiremente if all of the <br />conditions • • - <br />1. The owner Of operator can c4ean up the release from the prhnatry containment <br />VAthin 8 hours after t1he release was detectedorshould have been deteebed. <br />1 <br />2. The release has not escaped the secondary containment. F <br />ANID <br />3. The rehmse does Pot increase the hazard of fire or explosion. <br />AND UT F <br />4- The release does not cause dets�-on of the Secondary containnient. F <br />'Ll JT <br />�' F♦ Y •.., �•a.. ..:� i _a: • -r •. - .� �,,, • 7 � '..♦.J. •. 1. <br />Operator's - � � • t -a Ps -a = v <br />�. 1Facility name: <br />�►_Hazardous sub --lance found in the secondary containment: <br />Quantity. JQ& j� t- Concentratiom <br />� r <br />The method and locafion of disposal of the released hazardous subeale- <br />a�..-..7__1--�.a��l[1ri7l�:l.:�=.!\"lY«f.. <br />l- •la ♦ MI •..n. taken• -.•moi - UST * i..prevent future -- <br />-_, _ r. # • <br />maintenance receipt: ti. ? s v_' <br />_ .�a.� .,.. .... <br />z,::• - Z4021 -1I I kiwojmL;.ii;_. Fes. <br />f <br />AUch PrintOut from con6nuous; monitoring system, maintenance receipts. manifests, phoWs, etc-- <br />RAtein this <br />*See the Califomia Code of Regulations, Title 23, SectlIon 2651 and California Heafth & Safety Code SecUon <br />25294 for further reqLdrernerft. <br />