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SAN JOAQUIN COUNTY 0 D <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 0- 3�A. EMERGENCY LEVEL: II III PHS-EHL # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION 510 6 7 5-6168 <br /> Name: Karan rlark Phone:) <br /> Company: Shell Oil Company <br /> Address: 1390 Willow Pass Road, Suite 900 , Concord, CA 94524 <br /> Designated Employee Name: Karen Clark Phone: (510) 675-6163— <br /> Reporting <br /> 75-616 8Reporting Agency Name: San Joaquin County PHS-EHD <br /> Address: 445 N. San Joaquin Street, Stockton, CA 95201 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2575 Country Club / Stockton <br /> (Best Physical Description) <G�nor County) Circle One <br /> Date of Discharge: Tank leak (gasoline) <br /> Date Notified: 12/09/94 Time: 12 : 17 um <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Shell Oil Companv <br /> Contact Person: see above Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Fuel release from tank -VRtam <br /> Volume: _ 8 , 500 gallons reported per operator records <br /> Chemicals: Gasoline (RU gasoline) <br /> Circumstances: Tank leak due to corrosion <br /> F. ACTION TAKEN Product removed from system. Contamination assessed. <br /> SITE STATUS Intend to remove tanks . Free product removal from soil Gct'�j <br /> EH 22 013 (Rev.4/91) <br />