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SAN J O A Q U I N Environmental Health Department <br /> NlY COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EMERGENCY LEVEL: EHD LOG# <br /> 0 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: COLLW66CY <br /> Name: Aldo Basurto Phone: (925)467-3000 <br /> Company: Safeway City: Stockton <br /> Address: 6425 N Pacific Ave <br /> Designated Employee: John Alaniz <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 6425 N Pacific Ave Stockton, CA 95207,APN 09741031. Spill City: STOCKTON <br /> Physical Description: occurred at dispenser 5/6. 0 Incorporated ❑ Unincorporated <br /> Date of Discharge: May 12, 2019 Date Notified: May 13, 2019 Time Notified: 8:15 am <br /> RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Safeway, Inc. <br /> Contact Person: Ron Lee Contact Phone: (925) 469-7513 <br /> Mailing Address: 6000 Stoneridge Mall Rd <br /> City: Pleasanton State: CA ZIP: 94588 <br /> DESCRIPTION <br /> Material: Regular Gasoline Amount: 4.00 ❑ lbs Z gal ❑ cu ft <br /> Type of Discharge: Spill occurred by a mechanical problem in dispenser 5/6 <br /> Circumstances: EHD was notified by CalOES <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> ACTION TAKEN <br /> Spill was cleaned up using absorbent pads. Dispenser has been shut down and a work order to fix the dispenser has been <br /> submitted. <br /> SITE DISPOSITION <br /> The spill was properly cleaned up. EHD has abated the complaint. <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 />