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10. °kI!y c SAN JOAQUIN COUNTY � D <br /> z' ENVIRONMENTAL HEALTH DEPARTMENT b <br /> Q: •a <br /> 600 East Main Street Stockton ■ CA 95202-3029 <br /> : bum . <br /> (209) 468-3420 ■ Fax: (209) 464-0138 ■ Web: www.sjgov.org/ehd <br /> CgC'FORN�P <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL X I II III EHD LOG# 0'/ c_ <br /> B. SOURCE OF INFORMATION <br /> NAME: BRANDON EDES PHONE: (336) 315-2806 <br /> COMPANY: VEEDER-ROOT CITY: <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: 1987 W ELEVENTH ST CITY TRACY Incorporated <br /> Best Physical Description <br /> X Unincorporated <br /> DATE OF DISCHARGE: 8/1/2007 <br /> DATE NOTIFIED: 8/1/2007 TIME: 7:45 A.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: SAFEWAY <br /> CONTACT PERSON: WILL KAUFMAN PHONE: (209) 830-2950 <br /> PHYSICAL ADDRESS: 1987 W ELEVENTH ST TRACY CA 95376 <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: SPILL <br /> VOLUME: APPROXIMATELY 1.5 GALLONS <br /> CHEMICALS: GASOLINE <br /> CIRCUMSTANCES: CUSTOMER TOPPING OF TANK SPILLED GASOLINE <br /> F. ACTION TAKEN <br /> ABSORBENT SPILL KIT USED TO CONTAIN AND CLEAN UP SPILLED GASOLINE. ABSORBENT PLACED INTO HAZARDOUS WASTE <br /> BARRELL AT THE SITE TO BE PICKED UP AS REGULARLY SCHEDULED. <br /> SITE DISPOSITION <br /> NO ADDITIONAL FOLLOW UP NEEDED AT THIS TIME. <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />