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� -2 <br /> SAN JOAQUIN COUNTY SAN JOAQUIN OUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENTOFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL HAZARDOUS REL; ®AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY POST OFFICE sox 1809 <br /> PHONE(209)468-3420 JAN 112.011 STOCKTON,CA 95201-1809 <br /> �' 7 PHONE(209)468-3300 <br /> Part[: General Information MNJ0aQQi <br /> Business,Farm or Ranch Name: Site Locations/Address(include zips cyode):A 'Fr1UCRUt1:hqERGENC §ERV Phone No: <br /> 01 c� 1 z <br /> Mailing Address(if different from above): Description of BusincsslOperation(Farm,Nur ery,Etc.): Nearest Crossroad: <br /> 4� V i�S LL LJi d-2 �� � P �c� u �v --W <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 p 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 1 time <br /> JFMAMJJASOND <br /> }� � � ,�QCJMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> ertify that the abov, hazardous material information is true and correct to the best of my knowledge. <br /> �-, �2 �� Additional Inven�torY Sheets Attached: <br /> ig ature Name(please print) Date Yes L?S 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. 10125107) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />