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f � <br /> J A N J U A Q U I!1 Environmental Health Department <br /> COUNTY 0CC) IJ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EMERGENCY LEVEL: EHD LOG# l <br /> ❑x I-No Evacuation/Local Response Only ❑II-Evacuation and/or In-County Mutual Aid Needed ❑III-Evacuation and/or State/Regional Mutual Aid Needed <br /> SOURCE OF INFORMATION RECORD ID: COPAUHORN <br /> Name: Kelly Durrrer Phone: (209) 858-3370 <br /> Company: Super Store Industries City: Lathrop <br /> Address: 16888 S. McKinley Avenue <br /> Designated Employee: Lydia Baker <br /> Reporting Agency: San Joaquin County Environmental Health Department <br /> Agency Address: 1868 E Hazelton Ave, Stockton, CA 95205 <br /> LOCATION AND DATE OF DISCHARGE: <br /> Location - Best South of the maintenance shop at 16888 South McKinley, City: LATHROP <br /> Physical Description: Lathrop, CA 95330 <br /> Z Incorporated F1 Unincorporated <br /> Date of Discharge: November 20, 2018 Date Notified: November 20, 2018 Time Notified: 7:35 am <br /> RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: SUPER STORE INDUSTRIES <br /> Contact Person: KELLY DURRER Contact Phone: (209) 858-3370 <br /> Mailing Address: 16888 SOUTH MCKINLEY AVENUE <br /> City: LATHROP State: CA ZIP: 95330 <br /> DESCRIPTION <br /> Material: Diesel Exhaust Fluid Amount: 45.00 ❑ lbs El gal ❑ cu ft <br /> Type of Discharge: Spill <br /> Circumstances: Forklift punctured a tote causing the release. <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> ACTION TAKEN <br /> Super Store Industries to provide EHD with disposal records for waste generated. <br /> SITE DISPOSITION <br /> Clean-up was completed by Super Store Industries. One 1x1 yard bag and four 55 gallon drums of waste was generated. <br /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />