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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N; <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c ej (209) 468-3420 • Fax:(209) 464-3433 • Web:www.sigov.org/ehd <br /> {.� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x I ❑ II ❑ ill EHD LOG# _ r� <br /> B. SOURCE OF INFORMATION <br /> NAME: Michelle Henry PHONE: (209)468-3454 <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: Michelle Henry PHONE: (209)468-3454 <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE _ <br /> LOCATION: El Incorporated <br /> Best Physical 6649 Embarcadero Ave CITY Stockton <br /> Descr tion ❑ Unincorporated <br /> DATE OF DISCHARGE: Uknown <br /> DATE NOTIFIED: 10/6/2014 TIME: 6:30pm <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: Village West Marina <br /> CONTACT PERSON: Terry Craig PHONE: (209) 951-1551 <br /> PHYSICAL ADDRESS: 6649 Embarcadero Ave Stockton CA 95219 <br /> MAILING ADDRESS: Same <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: Leak <br /> VOLUME: unknown <br /> CHEMICALS: diesel <br /> CIRCUMSTANCES: Leaking aboveground piping along dock <br /> F. ACTION TAKEN <br /> Diesel taken out of service until further notice <br /> SITE DISPOSITION <br /> Diesel taken out of service until further notice. COS fire contacted to oversee repairs <br /> Revised 11/03/14 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />