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SAN JOAQUIN COUNTY ��� �® SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY DEC 2 2014 210E E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> Part I: General Information SAV JOAQUIN GOUMY PHONE(209)953-6000 <br /> ct t EMERGENCYE OF SEPMGM <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> 143e4 <br /> Mailing Address(if different from above): '"Al. escription of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> V 3 Ylr• <br /> 'DWA,wsr�e S d. S ICtc pof ' l vdsAkvv /7� <br /> Emergency Contact Person: Phone No: Pesti ' e Permit 1 ID No: r-p-, <br /> strict: <br /> Fmw-,e,5 & scd , � ���� 20-30-3 3 a16'3ib 3 wo iip�� e- <br /> Part Q: Hazardous Material Informati Refer to de Agricultural Hazard Material Worksheet for the materials that should be listed below and their reportable uantities <br /> Material Name DOT ftContainer 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 I time <br /> ,Q �; � "� JFMAMJJASOND � <br /> <br /> <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND RECEIVED <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> 211�1 rtify that the above do material information is true and correct to the best of my knowledge. AGR, COMM. - STOCKI`ON <br /> a <br /> lib SI �'0- �! Additional Invento Sheets Attached: <br /> Signature Name(please rint) Da <br /> Yes NOD <br /> (Return completed f m(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. 10/15/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />