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Discharge Notification Form <br /> THREE B'S TRUCK & AUTO PLAZA <br /> 14749 North Thornton Road, Lodi, California <br /> Part A: Discharge Information <br /> General information when reporting a spill to outside authorities <br /> Basic Information <br /> Facility name, address and contact number: Three B's Truck &Auto Plaza <br /> 14749 North Thornton Road <br /> Lodi, California <br /> Office: 209 368-8100 Office <br /> Owner/Operator, address and contact number: Tony Khatirine <br /> 14749 North Thornton Road <br /> Lodi, California <br /> Office: (209) 368-8100 (Office) <br /> Emergency Coordinator, office address and Mr. Tony Khatirine <br /> contact number: 14749 North Thornton Road <br /> Lodi, California <br /> Work (Office): (209) 368-8100 <br /> Cell (24 hour) :(209) 200-7258 <br /> Alternate Facility Employee: Francisco Avila— Facility Repair Supervisor <br /> Work (Office): (209) 368-8100 <br /> Cell (24 hour): (209) 649-7425 <br /> Spill Information <br /> Type of oil: Discharge Date and Time: <br /> Quantity released: Discovery Date and Time: <br /> Quantity released to a water body: Discharge Duration: <br /> Location/Source: <br /> Actions taken to stop, remove, and mitigate impacts of the discharge: <br /> Affected media: <br /> ❑ air ❑ storm water sewer/POTW <br /> ❑ water ❑ dike/berm/oil-water separator <br /> ❑ soil ❑ other: <br />