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SA N 10 A Q U I N COPY Environmental Health Department <br /> CC)UtilIY- - <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EMERGENCY LEVEL: EHD LOG# 14 <br /> ❑x 1-No Evacuation/Local Response Only ❑II-Evacuation and/or In-County Mutual Aid Needed ❑III-Evacuation and/or State/Regional Mutual Aid Needed <br /> SOURCE OF INFORMATION: RECORD ID: C05F2RWZA <br /> Name: Dawna Newton Phone: (971) 242-3181 <br /> Company: Safeway City: <br /> Address: <br /> Designated Employee: Lydia Baker <br /> Reporting Agency: San Joaquin County Environmental Health Department <br /> Agency Address: 1868 E Hazelton Ave, Stockton, CA 95205 <br /> LOCATION AND DATE OF DISCHARGE: <br /> Location - Best 6425 N. Pacific Avenue, Stockton, CA 95207. APN 09741031 City: STOCKTON <br /> Physical Description: <br /> ❑ Incorporated 0 Unincorporated <br /> Date of Discharge: November 06, 2019 Date Notified: November 06, 2019 Time Notified: <br /> RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: SAFEWAY FUEL CENTER#2707 <br /> Contact Person: DAWNA NEWTON Contact Phone: (971) 242-3181 <br /> Mailing Address: PO BOX 29096, MS 6516 <br /> City: PHOENIX State: AZ ZIP: 85038 <br /> DESCRIPTION <br /> Material: Gasoline Amount: 4.00 ❑ lbs Z gal ❑ cu ft <br /> Type of Discharge: Leak <br /> Circumstances: Customer's fuel line was cut and leaked when filled with gasoline. <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> Material: Amount: ❑ lbs ❑ gal ❑ cu ft <br /> Type of Discharge: <br /> Circumstances: <br /> ACTION TAKEN <br /> Facility personnel completed clean-up of spill. EHD to verify disposal records for waste generated during the next routine <br /> hazardous waste inspection. <br /> SITE DISPOSITION <br /> Clean-up has been completed. <br /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />