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V <br />4, <br />SAN JOA+QUIN COUNTY <br />aENVIRONMENTAL HEALTH DEPARTMENT <br />j 1 868 East Hazelton Avenue, Stockton, CA 15205-6232 <br />p (209) 468-3420 Fax: (209) 464-3433 -Web: www.siaov.ora/ehd <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />A. EMERGENCY LEVEL ® 1 ❑ II ❑ III EHD LOG# -I,� <br />B. SOURCE OF INFORMATION <br />NAME: <br />Dennis Bock <br />PHONE: <br />425-427-7653 <br />COMPANY: <br />Costco <br />CITY: <br />Manteca <br />ADDRESS: <br />2440 Daniel Street, Manteca, CA <br />DESIGNATED EMPLOYEE NAME: <br />Muniappa Naidu <br />PHONE: <br />(209) 468-3439 <br />REPORTING AGENCY NAME: <br />San Joaquin County Environmental Health Department <br />ADDRESS: <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />r.. 10('.ATInN ANn nATF nF nI Sr.HARr.F <br />LOCATION: <br />Best Physical <br />tion <br />2440 Daniel Street <br />CITY <br />Manteca <br />rx1 incorporated <br />[3Desai Unincorporated <br />DATE OF DISCHARGE: <br />Tuesday, November 5, 2013 <br />DATE NOTIFIED: <br />11/5113/ <br />TIME: <br />5.00 pm <br />n RFPnN.I;IRI F P1=RSONIRt1SINFSS <br />NAME OF BUSINESS: <br />COStCO <br />CONTACT PERSON: <br />Dennis Bock PHONE: <br />1 425-427-7653 <br />PHYSICAL AD DRESS: <br />2440 danlel Street, Manteca <br />MAILING ADDRESS: <br />F nFfir.RiPTinKi <br />TYPE OF DISCHARGE: <br />Unleaded Gasoline <br />VOLUME: <br />6 to 8 gallons <br />CHEMICALS: <br />unleaded Gasoline <br />CIRCUMSTANCES: <br />Customer error - went into the gutter <br />Ar:TInN TAKFN <br />Clean harbors hired to perform clean up <br />SITF DISPOSITION <br />Jean Op in progress <br />Revised 08/02/12 Page 1 of 2 . ; NOTIFICATION OF HAZ WASTE DISCHARGE <br />