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r <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave., Stockton•CA 95205 <br /> ' 4 (209)468-3420•Fax:(209)468-3433 ■ Web:www.sjcehd.com <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL x I II III EHD LOG# d <br /> B. SOURCE OF INFORMATION <br /> NAME: Mike Karvelot PHONE: (510)445-2285 <br /> COMPANY: Quik Stop Markets CITY: Fremont <br /> ADDRESS: 4567 Entgerprise <br /> DESIGNATED EMPLOYEE NAME: Jeffrey Wong PHONE: (209)468-0335 <br /> REPORTING AGENCY NAME: SJC EHD <br /> ADDRESS: 1868 E.Hazelton,Stockton <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: 2285 E.Fremont CITY Stockton Incorporated <br /> Best Physical Description <br /> x Unincorporated <br /> DATE OF DISCHARGE: October 10,2013 <br /> DATE NOTIFIED: October 11,2013 1 TIME: 1 m <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: Quik Stop Market#39 <br /> CONTACT PERSON: Mike Karvelot PHONE: (510)445-2285 <br /> PHYSICAL ADDRESS: 4567 Entgerprise,Fremont CA 94538-7605 <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: unauthorized <br /> VOLUME: Approximately 3 gallons <br /> CHEMICALS: gasoline <br /> CIRCUMSTANCES: Released from primary to secondary containment when piping was damaged;possible release to soil <br /> F. ACTION TAKEN <br /> Pumps shut down. Trench covered to prevent access. UST facility being monitored as usual. <br /> SITE DISPOSITION <br /> Piping being repair;soil sample to be collected for analysis to verify if release to environment has occurred <br /> r <br /> PROP 65 Revised 07/27/12 <br />