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<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK AUG 12 2015
<br /> RESPONSE PLAN—PAGE 2
<br /> VI. REPORTING AND RECORD KEEPING NMENTA
<br /> We will report/record any overfill,spill,or unauthorized release from a UST system as indicated in this plan t j c Q i u"a0ft
<br /> Recordable Releases: Any unauthorized release from primary containment which the UST operator is able to clean up within eight(8)hours after the release was
<br /> detected or should reasonably have been detected,and which does not escape from secondary containment,does not increase the hazard of fire or explosion,and does
<br /> not cause any deterioration of secondary containment,must be recorded to the facility's monitoring records Monitoring records must include
<br /> Y The UST operator's name and telephone number;
<br /> A list of the types,quantities,and concentrations of hazardous substances released,
<br /> Y A description of the actions taken to control and clean up the release;
<br /> Y The method and location of disposal of the released hazardous substances,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 future releases,
<br /> Y A description of the method used to reactivate interstitial monitoring after replacement or repair of primary containment
<br /> Reportable Releases: Any overfill,spill,or unauthorized release which escapes from secondary containment(or pnmary containment 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 arc also recordable
<br /> Within 24 hours after a reportable release has been detected,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 stored product/waste will
<br /> be removed from the UST to prevent further releases or facilitate corrective action If an emergency exists,we will notify the State Office of Emergency Services
<br /> Within five(5)working 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 information is known at the time of filing the report
<br /> Y The UST owner's or operator's name and telephone number;
<br /> Y A list of the types,quantities,and concentrations of hazardous materials released;
<br /> Y The approximate date of the release,
<br /> Y The date on which the release was discovered,
<br /> Y The date on which the release was stopped,
<br /> Y A description of actions taken to control and/or stop the release;
<br /> Y 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 m surface water contamination due to the release,
<br /> Y The method(s)of cleanup implemented to date,proposed cleanup actions,and a schedule for implementing the proposed actions,
<br /> Y The method(s)and location(s)ofdisposal of released hazardous materials and any contaminated soils,groundwater,or surface water
<br /> Y Copies of any hazardous waste manifests used for oft=site transport of hazardous wastes associated with clean-up activity;
<br /> Y A description of proposed methods for any repair or replacement of UST system primary/secondary containment systems;
<br /> Y A description of additional actions taken to prevent future releases
<br /> We will follow the reporting procedures described above if any of the following conditions occur:
<br /> Y A recordable unauthorized release can not be cleaned up or is still under investigation within eight(8)hours of detection;
<br /> Y Released hazardous substances are discovered at the UST site or in the surrounding area,
<br /> Y Unusual operating conditions are observed,including erratic behavior of product dispensing equipment,sudden loss of product,or the unexplained presence of
<br /> water in the tank,unless system equipment is found to be defective and is immediately repaired or replaced,and no leak has occurred;
<br /> Y Monitoring results from UST system monitoring equipment/methods indicate that a release may have occurred,unless the monitoring equipment is found to be
<br /> defective and is immediately repaired,recalibrated,or replaced,and additional monitoring does not confirm the initial results
<br /> Record Retenfion: Monitoring records and written reports of unauthorized releases must be maintained on-site(or off-site at a readily available location,if approved
<br /> by the local agency)for at least 3 years. Hazardous waste shipping/disposal records(e g,manifests)must be maintained for at least 3 years from the date of shipment
<br /> VII. OWNER/OPERATOR SIGNATURE
<br /> CF,RTiFICATION: fy that the information provided herein is true and accurate to the best of my knowledge.
<br /> OWNERK)P _ AT1tJ� DATE K70
<br /> -. 6/12/2015
<br /> O NEWOPE yOR NAME art OWNER/OPERATOR TITLE tin
<br /> -Q,� S Vr'U►� � t�1 m I U 0.n S G i
<br /> (Agency Use Only) This plan has been reviewed and, ❑Approved ❑Approved With Conditions ❑Disapproved
<br /> Local Agency Signature: Date:
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