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Consolidated*ntingency Plan <br /> Environmental Health Division(CUPA) JAN 0 7 2003 for Hazardous Materials,Hazardous Waste&Underground Storage Tanks <br /> Instructions for completing this document can beffound in the"Consolidated Contingency Plan Instruction&Information Booklet" <br /> Submit completed document to Environmedtd&61th <br /> FACILITY IDENTIFICATION /OP6hAiIONS OVERVIEW <br /> Jackpot Food Mart 2087 1/2/03 <br /> 1434 W. Yosmite, Manteca CA <br /> 3 Check elements covered by this consolidated plan: <br /> Hazardous Materials❑ Hazardous Waste ❑ Underground Storage Tanks [� <br /> 4 Supplemental elements submitted: rrTT�� <br /> UST Written Monitoring Plan LA <br /> 5 e.g.paining connector) lNuiuENTAL UPERA I IUN5 (e.g.rest maintenance) <br /> C-Store/Gas Station <br /> e.g.enernical spills,me,eartnquaXe,e c <br /> Gasoline Spills <br /> EMERGENCY COORDINATOR & ON-SITE TECH ADVISORS I INTERNAL RESPONSE <br /> Identify your Emergency Coordinator&On-site Technical Advisors: <br /> Name/Position.. '., Jim Codling, Manager/Joyce Maund, Coordinator <br /> Emergency Coordinator: Address: 2737 W. Commodore Way, Seattle, WA 98199 <br /> — <br /> Must have the authority to classify the ' Phone#s: Day:: 206-288.8450 After hours: 2062852400 <br /> release,make management decisions, 8 Responsible for: spill prevention contacting facility responders <br /> determine appropriate response authodzin9 ill a res nae work <br /> ['emergency assessment l P Po <br /> (check all that apply) management — <br /> Person is: E]on-site or ® oncall <br /> Interfacing with public emergency <br /> ❑Initiating alarms responders <br /> ❑agency notification ❑other: <br /> s ! Alternate#1 Alternate#2 <br /> Name I Position: Alfred Youman Brandi Lilygren <br /> Address: 1434 W.Yosemite 941 Colt Tower Way <br /> Alternate Emergency Coordinators: city: Manteca Chico <br /> List In order of responsibility. Zip: 98336 95928 <br /> i Day phone: 209-239-1792 530-864-7892 <br /> After hours phone: 209-239-1792 530-864-7892 <br /> Person is: on-site or ❑on-call I ❑on-alta or Is oncall <br /> fl Onsite Technical Advisors <br /> Owner: Supervisor. <br /> Available to provide site-specific technics, Make call to Time Oil Co. _ Di etch <br /> advice to off-site emergency responders) Manager: Alfred Youman Other: <br /> „ Identify type of Internal response: <br /> f; Team Members(name or position): Responsibilities: <br /> ❑ Internal facility <br /> response team Alfred Youman Lessee/Manager <br /> Option (attach additional pages if needed: 2. <br /> s: <br /> indicate an attachment by checking <br /> 8. <br /> u,is bos ) <br /> (check 4. <br /> 13 one or Name: <br /> Describe role I responsibilities: <br /> more) _-- <br /> '.. ❑ Contractor _ <br /> address: <br /> phone#:-- <br /> .............................................................................................................................. <br /> Page: 1 Facility Identification, Emergency coordinator&Tech Advisors, Internal response <br />