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SAN JOAQUIN COUNTY <br /> COPY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209)468-3420 • Fax:(209)464-3433 • Web:www.sogov.org/ehd <br /> C4CiFOR�`P <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE JEHDLOG#1 <br /> EMERGENCY LEVEL: <br /> ❑X I-No Evacuation/Local Response Only ❑ I-Evacuation and/or In-County Mutual Aid Needed ❑ I I I-Evacuation and/or Regional/State Mutual Aid Needed <br /> SOURCE OF INFORMATION <br /> NAME: Randall Perez PHONE: 1800-424-8802 <br /> COMPANY: California Office of Emergency Services CITY: Mather <br /> ADDRESS: 3650 Schriever Avenue, Mather, California 95655-4203 <br /> DESIGNATED EMPLOYEE NAME: Hata Saeed PHONE: (209) 953-6212 <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> LOCATION AND DATE OF DISCHARGE <br /> LOCATION: Villag a West Marina, 6649 Embarcadero Drive cin Stockton 0 Incorporated <br /> Best Physical <br /> Description Stockton, CA 95219 ❑ Unincorporated <br /> DATE OF Unknown <br /> DISCHARGE: <br /> DATE 05/0$/2017 TIME: 08:35am <br /> NOTIFIED: <br /> RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: Village West Marina <br /> CONTACT PERSON: Time Fontaine PHONE: (209) 951-1551 <br /> PHYSICAL ADDRESS: Village West Marina 6649 Embarcadero Drive Stockton, CA 95219 <br /> MAILING ADDRESS: Village West Marina 6649 Embarcadero Drive Stockton, CA 95219 <br /> DESCRIPTION <br /> TYPE OF DISCHARGE: I Oily substance on the surface of the water <br /> VOLUME: Unknown <br /> CHEMICALS: Unknown <br /> CIRCUMSTANCES: Unknown <br /> ACTION TAKEN <br /> Absorbent booms were placed to contain the sheen. The cause of the sheen is still under <br /> investigation. <br /> SITE DISPOSITION <br /> Facility is conducting a daily inspection to determine the source and the cause of the sheen. <br /> Revised 6/01/2015 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />