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SAN JOAQUIN <br /> Environmental Health Department <br />COUNTY- <br />EMERGENCY RESPONSE RECORD <br />Date: March 29, 2022 Short Term #: COGCKSBAT <br />Premise Address: 25501 GATEWAY BLVD City: TRACY <br />Premise DBA: COSTCO Cross Street: SCHULTE ROAD <br />Premise Owner: COSTCO Owner's Phone: (209) 839-2586 <br />Mailing Address: 999 LAKE DRIVE Owner City: ISSAQUAH <br />Facility Contact: COSTCO Contact Phone: (209) 839-2586 <br />RP DBA: CERTIFIED FREIGHT LOGISTICS <br />Onsite RP Name: ADAM COSTA Onsite RP Phone: (209) 201-6184 <br />Mailing Address: PO BOX 5819 RP City: SANTA MARIA <br />RP Contact: MARK ZARATE Contact Phone: (805) 310-7648 <br />NATURE OF RESPONSE (explosion, spill, leak, fire, or abandoned/dumped material) <br />50 GALLONS OF DIESEL RELEASED AND IMPACTED ASPHALT <br />Time Received: 4:29 pm Time of Arrival: 5:42 pm Time of Departure: 6:42 pm <br />PERSONS AT SCENE <br />NAME AGENCY PHONE TOA TOO <br />VICKY VANG-LEE EHD (209) 616-3028 5:42 pm 6:42 pm <br />ADAM COSTA CERTIFIED FREIGHT LOGISTI (209) 201-6184 <br />DEREK COLLINS COSTCO (209) 839-2586 <br />CAMREN HERRIN J&E TRUCK SERVICE (209) 465-3162 <br />MATERIAL! CLASSIFICATION chemical involved <br />MATERIAL AMOUNT SOLID (lbs) LIQUID (aaf) GAS (Cu ft) COMMENTS <br />DIESEL 50.00 0 0 0 <br />0 0 El <br />0 0 0 <br />REFERRALS AND NOTIFICATIONS <br />REFERRED TO (NAME AND ADDRESS) DATE MAILED <br />Date Prop 65 Completed: March 30, 2022 Date UAR Completed: <br />IF PERSONS EXPOSED and/or INJURED, "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? DYES LINO <br />Page 1 of 2 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD