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i SAN 10AQUIN COPY Environmental Health Department NOTIFICATION OF HAZARDOUS WASTE DISCHARGE EMERGENCY LEVEL: EHD LOG# ❑x I-No Evacuation/Local Response Only ❑II-Evacuation and/or In-County Mutual Aid Needed ❑III-Evacuation and/or State/Regional Mutual Aid Needed SOURCE OF INFORMATION: RECORD ID: C00052713 Name: NATHAN JOHNSON Phone: (760)602-8700 Company: VERISK 3E City: CARLSBAD Address: 3207 GREY HAWK COURT Designated Employee: Elianna Florido Reporting Agency: San Joaquin County Environmental Health Department Agency Address: 1868 E Hazelton Ave, Stockton, CA 95205 LOCATION AND DATE OF DISCHARGE: Location-Best COSTCO GAS STATION PUMPS 2&4, 1630 E HAMMER LN City: STOCKTON Physical Description: STOCKTON, CA ❑x Incorporated ❑ Unincorporated Date of Discharge: September 25, 2020 Date Notified: September 25, 2020 Time Notified: 1:30 pm RESPONSIBLE PERSON/BUSINESS Name of Business: COSTCO WHOLESALE#38(GAS STATION) Contact Person: CHARLIE MORRIS Contact Phone: (209)478-2040 Mailing Address: PO BOX 35005 City: SEATTLE State: WA ZIP: 98124 DESCRIPTION Material: ANTIFREEZE Amount: 1.00 ❑ lbs ❑x gal ❑ cu ft Type of Discharge: SPILL Circumstances: VEHICLE LEAKED CAUSING—8 OZ.TO ENTER A STORM DRAIN CATCH BASIN Material: Amount: ❑ lbs ❑gal ❑cu ft Type of Discharge: Circumstances: Material: Amount: ❑ lbs ❑gal ❑cu ft Type of Discharge: Circumstances: ACTION TAKEN RESPONSIBLE PARTY PERFORMED SPILL CONTAINMENT&CLEAN-UP. EHD VERIFIED CLEAN-UP IS COMPLETE AND ISSUED NOTICE TO ABATE TO THE RESPONSIBLE PARTY. EHD NOTIFIED CITY OF STOCKTON STORMWATER DEPT. SITE DISPOSITION RESPONSIBLE PARTY TO MAINTAIN COPIES OF HAZARDOUS WASTE MANIFESTS FOR ALL CLEAN-UP DEBRIS ASSOCIATED WITH SPILL CLEAN-UP ON-SITE FOR REVIEW BY EHD DURING FACILITY'S NEXT ROUTINE HAZ WASTE INSPECTION. Page 1 of 2 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD