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4 <br />SAMAQUIN C PY Environmental Health Department <br /> <br />COUNTY <br /> <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />EMERGENCY LEVEL: EHD LOG # \2_ <br />El I - No Evacuation/Local Response Only <br /> LII II - Evacuation and/or In-County Mutual Aid Needed <br /> <br />III - Evacuation and/or State/Regional Mutual Aid Needed <br />SOURCE OF INFORMATION: RECORD ID. CO6BLV78R <br />Name: Chelsea Meddings Phone: (530) 570-6755 <br />Company: Broadbent & Associates 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 <br />Physical Description: <br />1501 N. Jack Tone Rd. <br />10ic pence a 2.,k4 <br />City: RIPON <br />El Incorporated El Unincorporated <br />Date of Discharge: January 30, 2022 Date Notified: January 30, 2022 Time Notified: 4:18 pm <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: FLYING J TRAVEL PLAZA #618* <br />Contact Person: JOEY CUPP Contact Phone: (865) 474-2826 <br />Mailing Address: 5508 LONAS RD <br />City: KNOXVILLE State: TN ZIP: 37939 <br />DESCRIPTION <br />Material: Diesel Amount: 15.00 D lbs 0 gal 0 cu ft <br />Type of Discharge: Spill <br />Circumstances: Customer overfilled their vehicle causing release <br />Material: Amount: 0 lbs D gal 0 cu ft <br />Type of Discharge: <br />Circumstances: <br />Material: Amount: D lbs 0 gal 0 cu ft <br />Type of Discharge: <br />Circumstances: <br />ACTION TAKEN <br />Site was cleaned up by facility employees. <br />SITE DISPOSITION <br />Clean-up is complete. <br />Page 1 of 2 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD