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CO0042155
EnvironmentalHealth
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2500 – Emergency Response Program
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CO0042155
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Entry Properties
Last modified
5/21/2019 3:58:58 PM
Creation date
2/13/2019 12:43:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0042155
PE
2546
STREET_NUMBER
1756
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
11721005
ENTERED_DATE
8/31/2016 12:00:00 AM
SITE_LOCATION
1756 N WILSON WAY
RECEIVED_DATE
8/31/2016 12:00:00 AM
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
ADMIN
Supplemental fields
FilePath
\MIGRATIONS\W\WILSON\1756\CO0042155.PDF
Tags
EHD - Public
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SAN JOAQUIN COUNTY COPY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> bit : 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209) 468-3420 • Fax: (209) 464-3433 • Web:www.sigov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE EHDLOG# �� L <br /> EMERGENCY LEVEL: <br /> ❑X I-No EvacuatlonlLocal Response Only ❑II-Evacuation and/or In-County Mutual Aid Needed [:] I I I-Evacuation and/or RegionaVState Mutual Aid Needed <br /> SOURCE OF INFORMATION <br /> NAME: Lisa Medina PHONE: (209)468-3455 <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: Lisa Medina PHONE: 209 468-3455 <br /> REPORTING AGENCY NAME: San JOaq Uin County Environmental Health Department <br /> ADDRESS: 11868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> LOCATION AND DATE OF DISCHARGE <br /> LOCATION: ❑X Incorporated <br /> Best Physical 1756 N. Wilson Way CITY Stockton <br /> Description ❑ Unincorporated <br /> DATE OF 8/30/2016 <br /> DISCHARGE: <br /> DATE 8/30/2016 TIME: 9:18 a.m. <br /> NOTIFIED: <br /> RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: I My Mini Mart <br /> CONTACT PERSON: Joginder Lal I PHONE: 775 421-9978 <br /> PHYSICAL ADDRESS: 125 East Winnemuca Blvd., Winnemuca, NV 89445 <br /> MAILING ADDRESS: 125 East Winnemuca Blvd., Winnemuca, NV 89445 <br /> DESCRIPTION <br /> TYPE OF DISCHARGE: Approximately 2+ gallons gasoline spilled onto asphalt at Pump#4 <br /> VOLUME: " 2 gallons <br /> CHEMICALS: Gasoline <br /> CIRCUMSTANCES: Customer pumping at Pump #4 allowed overflow onto ground <br /> ACTION TAKEN <br /> Employee cleaned most of spill are(s) with absorbent materials (bentonite granulles), and <br /> removed clean-up waste materials to 5 - gallon Hazardous Waste Storage bucket on site. <br /> SITE DISPOSITION <br /> Notice to Abate issued on 8/31/2016 foor clean-up of remaining absorbent left on ground from <br /> original clean-up on 8/30/2016. Facility directed to remove waste materials to HHW facility with proof <br /> of receipt to the EHD within 30 days. <br /> Revised 6/01/2015 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />
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