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SAN JOAQUINCOUNTY <br /> I <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209)468-3420 ®Fax,(209)464-3433 ® Web:www.sigov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL rx1I ® II 171111 EHD LOG# q <br /> B. SOURCE OF INFORMATION <br /> NAME: Elena Manzo PHONE: 209-953-7699 <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: Elena Manzo PHONE: 209-953-7699 <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: x Incorporated <br /> Best Physic& 1960 W 11th Street CITY Tracy <br /> ® <br /> Description. Unincorporated <br /> DATE OF DISCHARGE: Wednesday,August 20, 2014 <br /> DATE NOTIFIED: Wednesday,August 20,2014 TIME: 9:51 am <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME of SINESS: CHEVRON STATION#201383 <br /> CONTACT PERSON: Ted Lamph PHONE: 925-842-7182 <br /> PHYSICAL: RESS: <br /> MAILING AC `'ESS: PO BOX 6004,ATTN: PERMIT DESK, SAN RAMON CA 94583 <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: Fuel spill <br /> VOLUME: 1 gallon <br /> CHEMICALS: Supreme fuel <br /> CIRCUMSTANCES: Nozzle malfunction during vehicle fueling <br /> F. ACTION TAKEN <br /> Spill was cleaned up by service station personnel; generated waste was placed into onsite hazardous waste container <br /> SITE DISPOSITION <br /> Clean-up complete <br /> Revised 08/02/12 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />