Laserfiche WebLink
07/23/2014 11:44 2095855 TWO GUYS0 PAGE 03/04 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Ha2wlton Ave., Stockton, CA 95205 "ED <br /> Telephone:(209)4683420 Fax.(209)468-3433 web; s1gov;ora/ehd <br /> RECORDING REQUIREMENTS JUL 2 3 2014 <br /> FOR UNAUTHORIZED RELEMMONMENTAL HEALTH <br /> stator is r DEPARTMENT <br /> An owner oro <br /> p 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 the <br /> conditions below are true.. <br /> 1. 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. T F <br /> AND <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 fulfilled you must re rt he release to the San Joaquin County <br /> Environmental Health Department and.other agencies as appropriate. Date of release: ' '{ <br /> Operator's name: &U.Tphone Number. 4-, (` <br /> Facility dame: . AeF ,/Facility Address: /+�7 j r <br /> Hazardous substance found in the*secondary containment:Do L(W Att�Ti ,�;O <br /> ylew <br /> E 5 CA witWMW_Aq <br /> Quantity: Concentration: p ' OF 00 <br /> Description of the actions taken to control and clean up the release: <br /> The method and location of disposal of the released hazardous substance: Nr TowjzL I A' <br /> Cly ....-- <br /> Description of actions taken to repair the LEST and to prevent future releases. Attach a copy of the <br /> maintenance receipt: It/ Ir'h4cp:p t j+ sAM <br /> Describe how the monitoring system was reactivated after repairs or replacement: <br /> Attach printout from continuous monitoring system, maintenance receipts, manifests, 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,Title 23, Section 2651 and California Health &Safety Cale Section <br /> 25294 for further requirements. <br />