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s <br /> S A NJ O A Q U IN Environmental Health Department <br /> C.0U NTY <br /> EMERGENCY RESPONSE RECORD <br /> Date: September 25, 2018 Short Term#: CORNGBBKR <br /> Premise Address: 1630 E HAMMER LN City: STOCKTON <br /> Premise DBA: COSTCO WHOLESALE CORPORATION Cross Street: <br /> Premise Owner: COSTCO WHOLESALE CORPORATION Owner's Phone: (425)313-8100 <br /> Mailing Address: 999 LAKE DR Owner City: ISSAQUAH <br /> Facility Contact: COSTCO WHOLESALE CORPORATION Contact Phone: (425)313-8100 <br /> RP DBA: COSTCO WHOLESALE CORPORATION <br /> Onsite RP Name: CHARLIE MORRIS Onsite RP Phone: (209)478-2040 <br /> Mailing Address: PO BOX 35005 RP City: SEATTLE <br /> RP Contact: COSTCO LISCENSING Contact Phone: (425)313-6275 <br /> NATURE OF RESPONSE(explosion, spill, leak,fire,or abandoned/dumped material <br /> COSTCO GAS STATION HAD A GASOLINE SPILL ON 9/22/18 DUE TO CUSTOMER ERROR. --1/4 GAL SPILL, <1/4 <br /> GAL ENTERED A STORM DRAIN. COSTCO ATTENDANT CLEANED SPILL FROM PAVEMENT, GENERATED ONE <br /> 55-GAL DRUM OF HAZARDOUS ABSORBENT& BOOM. PATRIOT ENVIRONMENTAL SERVICES CLEANED STORM <br /> DRAIN, GENERATED ONE 55-GAL DRUM OF LIQUID WASTE PENDING ANALYTICAL. <br /> Time Received: 8:20 am Time of Arrival: 11:25 am Time of Departure: 1:00 pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Haza Saeed SJC EHD (209)915-6575 11:25 am 1:00 pm <br /> Charlie Morris Costco (209)478-2040 <br /> Jason Farnsworth City of Stockton 209 937-8155 <br /> MATERIAL/CLASSIFICATION chemical involved <br /> MATERIAL AMOUNT SOLID(Ibs) LIQUID(pall GAS(cu ft) COMMENTS <br /> Gasoline 0.25 ❑ 0 ❑ <br /> ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> Date Prop 65 Completed: September 25, 2018 Date UAR Completed: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑YES ❑NO <br /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />