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w RE EWM. <br /> SAN JOAQUIN COUNTY SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUSr+El, '��� OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E. Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 4zaNi inilUINCOUM STOCKTON,CA 95206 <br /> OFFICE OF_CNjrRGENCYSEWWHONE(209)953-6000 <br /> Part I:General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> } r <br /> ud g e t?V lr ti-e.,5R� <br /> Mailing Address(if different from above): _ ) Description of Business/Operation(Farm,rNursery,Etc.): Nearest Crossroad: <br /> 4.E3 L T. ✓ t Lt� A tf(i GLY RJ <br /> Emergency Contact Person: Phone No: Pesticide Permit I ID No: Fire District: <br /> ;_6 -36 -3 0 -3 My e- <br /> Part IL Hazardous Material Information Refer to the Ag ricultural Hazard Material Worksheet for the materials that should be listed below and their reportable quantitiesl <br /> Material Name DOT it Container Container Size Max.Number Circle the Months On Site Locations(s)on the property(e.g.in barn,NW <br /> Type of Containers corner of property) <br /> at any l time <br /> (LOD <br /> li 9— d T&-LA "D©G JFMAMJJASOND <br /> ] S C� JFMAMJJASOND <br /> e e t VD J 1;1-deg L9&F 2- JFMAMJJAS0ND <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> r <br /> e <br /> ��� �l� Additional Inven ary Sheets Attached: <br /> Signature Name(please pri90Date Ye No❑ <br /> (Return completed f m(s) to the San Joaquin County Agricultural Commissioner. Do not submit fees with inventory. Fee 1fayment will be <br /> collected based on ' voicing by the Environmental Health Dept.) (rev. 10115108) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />