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— SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton • CA 95202-3029 <br /> (20914685-3420 • Fax:(209)464-0138 • Web.- <br /> NOTIFICATION <br /> eb.NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL x I i ; II rIi EHD LOGO <br /> B. SOURCE OF INFORMATION <br /> NAME: Muruappa Naidu PHONE: 209-468-3439_ <br /> COMPANY: Environmental Health Department CITY: j Stockton <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: Mumappa Naidu PHONE: 209-468-3439 <br /> REPORTING AGENCY NAME: I San Joaquin County Environmental Health Department <br /> j ADDRFSS: 600 E.Main St., Stockton,CA 95202 <br /> C. LOCATION AND DATE OF DISCIiARGE <br /> €.00ATION: 1501 Jack I one Road CITY Ripon Inco orated <br /> Beer physical Des,:rip Cn <br /> X Unincorporated <br /> DATE OF DISCHARGE: Clnknoun <br /> DATE NOTIFIED: 7125109 TIME: 12.00pm <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OP BUSINESS: I Flying J <br /> I <br /> CONTACT PERSON: Jose Jimenez PHONE: <br /> PHYSICAL ADDRESS: 1501 Jack Tone Road, Ripon I <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: Diesel and Gasoline ` <br /> VOLUME. Unknown <br /> CHEMICALS: Diesel and Gasoline <br /> CIRCUMSTANCES: Unknown - found during sampling for piping removal <br /> F. ACTION TAKEN _ <br /> �i <br /> Referred to progrant for further aclion. <br /> I <br /> T SITE DISPOSI'I"ION -- - ---.— - � _ <br /> Further action required <br /> ER RECORD MODIFIER Revised 05!0 1/200 <br />