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y dopy <br /> ,0" `''" SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> `� (209) 468-3420 • Fax: (209)464-3433 • Web:www.sigov.orq/ehd <br /> R� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x I ❑ II ❑ III EHD LOG# Ito—4)75q <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: ❑ Incorporated <br /> Best Physical 25705 S. Patterson Pass Road CITY Tracy <br /> Description ❑x Unincorporated <br /> DATE OF DISCHARGE, May 20, 2016 <br /> DATE NOTIFIED: May 20, 2016 TIME: 100am <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: Shell <br /> CONTACT PERSON: Dave Harden PHONE: 661 9795271 <br /> PHYSICAL ADDRESS: 25705 S. Patterson Pass Road Tracy CA 95377 <br /> MAILING ADDRESS: 25705 S. Patterson Pass Road Tracy CA 95377 <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: Leak <br /> VOLUME: up to 500 barrels (21,000g) <br /> CHEMICALS: crude oil <br /> CIRCUMSTANCES: release from underground piping <br /> F. ACTION TAKEN <br /> Line was isolated between Tracy pump station and the next station North of Tracy pump station <br /> SITE DISPOSITION <br /> Scene stable,environmental contractors on site at time of EHD departure <br /> Revised 11/03114 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />