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x <br />aQur"•� SAN JOAQUIN COUNTY <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />V._1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />(209) 468-3420 • Fax: (209) 464-3433 • Web: www.sigov.org/ehd <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />A. EMERGENCY LEVEL Qx I ❑ II [:1111 EHD LOG# <br />B. SOURCE OF INFORMATION <br />NAME: <br />Gerardo Acuna <br />PHONE: <br />925-766-6939 <br />COMPANY: <br />Chevron <br />CITY: <br />San Ramon <br />ADDRESS: <br />PO BOX 6004 / L2375 -B3 <br />DESIGNATED EMPLOYEE NAME: <br />Elena Manzo <br />PHONE: <br />209-953-7699 <br />REPORTING AGENCY NAME: <br />San Joaquin County Environmental Health Department <br />ADDRESS: <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />C. LOCATION AND DATE OF DISCHARGE <br />LOCATION: <br />Best Physical <br />Description <br />6633 Pacific Avenue; adjacent to supreme spill <br />container <br />CITY <br />Stockton <br />❑x Incor orated <br />❑ Unincorporated <br />DATE OF DISCHARGE: <br />4/8/2014 (7:35 am) <br />MAILING ADDRESS: <br />DATE NOTIFIED: <br />Tuesday, April 8, 2014 <br />TIME: <br />4:08 pm <br />D. RESPONSIBLE PERSON/BUSINESS <br />NAME OF BUSINESS: <br />CHEVRON STATION #96171* <br />CONTACT PERSON: <br />Gerardo ACuna <br />PHONE: <br />1 925-766-6939 <br />PHYSICAL ADDRESS: <br />Approximately 3 gallons of supreme fuel was released during fuel transfer from the tanker <br />truck to the underground storage tank <br />MAILING ADDRESS: <br />PO BOX 6004 / L2375 -B3, San Ramon, CA 94583 <br />E. DESCRIPTION <br />TYPE OF DISCHARGE: <br />Accidental release <br />VOLUME: <br />Approximately 3 gallons <br />CHEMICALS: <br />Supreme <br />CIRCUMSTANCES: <br />Approximately 3 gallons of supreme fuel was released during fuel transfer from the tanker <br />truck to the underground storage tank <br />F. ACTION TAKEN <br />1/8/2014- Per responsible party, FM 186 and absorbent pads were utilized to contain and clean the spill. All generated <br />Haste was placed in the onsite hazardous waste drum, pending disposal. <br />SITE DISPOSITION <br />Site clean-up and restoration are complete <br />Revised 08/02/12 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />