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Environm �I th <br /> SAN JOA UIN <br /> )UN i \ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EMERGENCY LEVEL: EHD LOG# <br /> I� _143 <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: CORNGBBKR <br /> Name: Nathan Johnson Phone: (760)602-8703 7402 <br /> Company: Verisk 3E Company City: Carlsbad <br /> Address: 3207 Grey Hawk Ct <br /> Designated Employee: Haza Saeed <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 Costco Wholesale#38(Gas Station), 1630 E Hammer Ln, City: STOCKTON <br /> Physical Description: Stockton,CA 95210 <br /> ❑D Incorporated ❑ Unincorporated <br /> Date of Discharge: September 22, 2018 Date Notified: September 24,2018 Time Notified: 8:20 am <br /> RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: COSTCO WHOLESALE CORPORATION <br /> Contact Person: COSTCO LICENSING Contact Phone: (425)313-6275 <br /> Mailing Address: PO BOX 35005 <br /> City: SEATTLE State: WA ZIP: 98124 <br /> DESCRIPTION <br /> Material: Gasoline Amount: 0.25 ❑ lbs 0 gal ❑cu ft <br /> Type of Discharge: Accidental Release <br /> Circumstances: Human Error <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 /> Clean-up is completed. <br /> SITE DISPOSITION <br /> EHD is waiting for disposal records. <br /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />