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,>.•.__„� SAN JOAQUIN COUNTY <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> c• � (209) 468-3420 • Fax;(209) 468-3433 • Web;www.sigov.org/ehd <br /> a�!7`ORa <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 3-25-16 SHORTTERM#: C00041250 <br /> PREMISE ADDRESS:2905 W Benjamin Holt CITY: Stockton <br /> DBA:Chevron Extra Mile, CHEVRON STATION #94275* CROSS STREET:Plymouth Rd <br /> PREMISE OWNER:CHEVRON PRODUCTS COMPANY PHONE: <br /> OWNER'SADDRESS:P.O. BOX 6004, ATTN: PERMIT DESK CITY:SAN RAMON <br /> FACILITY CONTACT:TEENA TOWNSELL PHONE:(209)478-5555 <br /> RESPONSIBLE PARTY(RP)DBA:Chevron, as above <br /> RP NAME: PHONE: <br /> RP ADDRESS: CITY:Stockton <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Reportedly 1/2 gallons of 87 octane fuel spilled in the area around UDC 3/4 (the circumstances are <br /> unknown at this time). The spill was cleaned up using absorbent by the employees onsite. Waste <br /> absorbent was placed into the onsite hazardous waste container. <br /> TIME RECEIVED:4•00 pm TIME OF ARRIVAL:5:00pm TIME OF DEPARTURE:5. 42 pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Elena Manzo SJC EHD 209-953-7699 5 pm 5:42 pm <br /> Ve Tin Chevron 209-478-5555 Onsite onsite <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> (LBS) (GAL) (CU FT) <br /> 87 fuel X ❑N 1/2 spill <br /> waste absorbent ❑Y X N NA clean up debris <br /> o o <br /> o o <br /> ❑Y o <br /> o ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: NA DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOX/CSUBSTANCEEXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP X NARRATIVE X MAP ❑ ANALYTICAL DATA ❑ PROP 65/UAR ❑ FILE CREATED <br /> ❑ MANIFEST ❑ REFERRALS ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />