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SAN JOAQUIN COUNTY <br /> - ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 209 468-3420 • Fax:(209)464-3433• Web:www sjgov.orq/ehd <br /> -a�lFORC� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x I ❑ II ❑ III EHD LOG#B. SOURCE OF INFORMATION (209)468-3454 <br /> NAME: <br /> Michelle Henry PHONE: <br /> COMPANY: San Joaquin County Environmental Health Department CITY: <br /> Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> : <br /> Michelle Henry PHONE: <br /> DESIGNATED EMPLOYEE NAME (209)468-3454 <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: fnco orated <br /> 6649 Embarcadero Ave CITY Stockton <br /> Best Physical ❑ Unincorporated <br /> Desai tion <br /> DATE io DISCHARGE: Uknown <br /> 10/6/2014 TIME: 6:30pm <br /> DATE NOTIFIED: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: Village West Marina <br /> Ter Craig <br /> PHONE: (209) 951-1551 <br /> CONTACT PERSON: Terry g <br /> PHYSICAL ADDRESS: 6649 Embarcadero Ave Stockton CA 95219 <br /> MAILING ADDRESS: Same <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: Leak <br /> VOLUME: unknown <br /> CHEMICALS: diesel <br /> CIRCUMSTANCES: Leaking aboveground piping along dock <br /> F. ACTION TAKEN <br /> Diesel taken out of service until further notice <br /> SITE DISPOSITION <br /> Diesel taken out of service until further notice. COS fire contacted to oversee repairs <br /> Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br /> Revised 11/03/14 <br /> r� <br />