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Pq� " SAN JOAQUIN COUNTY <br /> 2 `r ENVIRONMENTAL HEALTH DEPARTMENT <br /> c: .+ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' (209)468-3420 • Fax: (209)464-3433• Web:wwwsiaov.ora/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE JEHDLOG#1 <br /> EMERGENCY LEVEL: <br /> NX I-No Evacuation/Local Response Only ❑II-Evacuation and/or In-County Mutual Aid Needed ❑III-Evacuation and/or Regional/State Mutual Aid Needed <br /> SOURCE OF INFORMATION <br /> NAME: Lisa Medina PHONE: 209 468-3455 <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: Lisa Medina PHONE: 209 468-3455 <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> LOCATION AND DATE OF DISCHARGE <br /> LOCATION: Approximately 2+ gallons gasoline spill at O Incorporated <br /> Best Pnysical CITY Stockton <br /> Description Northeast side of pump#4 onto asphalt ❑ Unincorporated <br /> DATE OF 8/30/2016 <br /> DISCHARGE: <br /> DATE 8/31/2016 TIME: 9:18 a.m. <br /> NOTIFIED: <br /> RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: My Mini Mart <br /> CONTACT PERSON: Joginder Lal PHONE: 775 421-9978 <br /> PHYSICAL ADDRESS: 125 East Winnemucca Blvd., Winnemucca, NV 89445 <br /> MAILING ADDRESS: 125 East Winnemucca Blvd., Winnemucca, NV 89445 <br /> DESCRIPTION <br /> TYPE OF DISCHARGE: Approximately 2+gallons gasoline spill onto asphalt at Pump#4 <br /> VOLUME: 2 gallons <br /> CHEMICALS: Gasoline <br /> CIRCUMSTANCES: Customer pumping at Purl allowed overflow onto ground <br /> ACTION TAKEN <br /> Employee cleaned most of spill area(s) with absorbent materials (bentonite granules), and <br /> removed clean-up waste materials to 5-gallon Hazardous Waste Storage bucket on site. <br /> SITE DISPOSITION <br /> Notice to Abate issued 8/31/2016 for clean-up of remaining absorbent left on ground from original <br /> clean-up on 8/30/2016. Facility directed to remove waste materials to HHW facility with proof of <br /> receipt to the EHD within 30 days. <br /> Revised 6/01/2015 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />