Laserfiche WebLink
SAN JOAQUIN COUNTY 1VED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN STAGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY JAN B 70ifl 2101 E.Earhart Ave.,suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> SAN JOAQUIN COUNW PHONE(209)953-6000 <br /> Part I:General Information OFECE OF WERGENCY SERMCE 8, <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> `� h . 10-QU ems � g � 8'G-yGzV <br /> Mailing Address(if different from above): Description of Busi ness/Ope ratio a(Farm,Nursery,Etc.): Nearest Crossroad: <br /> . 6 <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: Fire District: <br /> Part II: Hazardous Material Information Refer to the Ag ricultural Hazard Material Worksheet for the materials that should be listed below and their reportablequantities) <br /> Material Name DOT# Container Container Size Max.Number Circle the Months On Site Locationsfs)on the property(e.g.in barn,NW <br /> Type of Containers corner of property) <br /> at any 1 time <br /> SSC t�—� 2 G3 Iii �dC] JFMAMJJASOND " o <br /> C0'j O CJFMAMJJASOND d V�`i 0 � <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND �/-,--::z, i <br /> 7N 47�- <br /> JFMAMJJASOND �U) <br /> JFMAMJJASOND JAN u!J <br /> J Iry eeUNV <br /> JFMAMJJASOND AGRIC.COMM.LODI <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> I'certify that the above hazardous material information is true and correct to the best of my knowledge. <br /> t <br /> --2 dditional Inventory Sheets Attached: <br /> Signature Name(please print) Date <br /> Yes ❑ No❑ <br /> (Return completed form(s) to the San Joaquin County Agricultural Commissioner. Do not submit fees with inventory. Fee payment will be <br /> collected based on invoicing by the Environmental Health Dept.) (rev. 10115/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />