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Sk J O A Q U I NEnvironmental Health Department <br /> COUNTY Copy <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EMERGENCY LEVEL: EHD LOG# <br /> ❑x I-No Evacuation/Local Response Only ❑II-Evacuation and/or In-County Mutual Aid Needed ❑III-Evacuation and/or State/Regional Mutual Aid Needed <br /> SOURCE OF INFORMATION RECORD ID: COULADZQO <br /> Name: Shawn Woottlen Phone: (209) 346-1028 <br /> Company: Lathrop Fire City: <br /> Address: <br /> Designated Employee: Elena Manzo <br /> Reporting Agency: San Joaquin County Environmental Health Department <br /> Agency Address: 1868 E Hazelton Ave, Stockton, CA 95205 <br /> LOCATION AND DATE OF DISCHARGE: <br /> Location - Best 150 feet south of Harlan Road, into 17100 Harlan Rd. Lathrop CA City: LATHROP <br /> Physical Description: parking lot <br /> 0 Incorporated El Unincorporated <br /> Date of Discharge: June 05, 2018 Date Notified: June 05, 2018 Time Notified: 7:20 am <br /> RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Zapotlan EI Grande Inc <br /> Contact Person: Daniel Cardenes Contact Phone: (909)444-8572 <br /> Mailing Address: 38304 Hillcrest Drive <br /> City: Palmdale State: CA ZIP: 93551 <br /> DESCRIPTION <br /> Material: diesel Amount: 10.00 ❑ lbs 0 gal ❑ cu ft <br /> Type of Discharge: Accidental release <br /> Circumstances: Fuel tank punclute <br /> Material: diesel contaminated debri Amount: 220.00 ❑ lbs Z gal ❑ cu ft <br /> Type of Discharge: clean up debris <br /> Circumstances: clean up activities <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> ACTION TAKEN <br /> Absorbent applied to impacted pavement, all waste debris containerized pending disposal <br /> SITE DISPOSITION <br /> Clean up is complete <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 />