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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 - 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 20pg STOCKTON,CA 95206 <br /> / C <br /> PHONE(209)953-6000 <br /> Part I:General Information OmcANJ(3ApUlNCpUMy <br /> BusinessFarm or <br /> Ranch Name Site Loccations/Ad�dress(include zip code): 1�1 1V RWCpS Phone No: <br /> `Y1drI 4i /ld 4/1 /�.�'9��2Z 2 <br /> Mailing Address(if different from above): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> /g/ e5 /?Z <br /> Emergent Contact Person: Phone No: Pe icide Permit/ID No: Fire District: <br /> '04/ a 1344 5' 3 Q-/a • . �o Lt�oa�6r�d .�, <br /> Part II: Hazardous Material Information Refer to the Ag ricultural Hazard Material Worksheet for the materials that should be listed below and their reportable uantities <br /> Material Name DOT P Container Container Size Max.Number Circle the Months On Site Locations(s1 on the property(e.g.in barn,NW <br /> Type of Containers corner of property) <br /> at any 1 time <br /> FMAMJJAS <br /> JFMAMJJASOND / <br /> / h2 JFMAMJ SO <br /> 4 0G� (� MAMJJASON <br /> 6 40JFMAMJJASO D <br /> 4243 /� JFMAMJJASOND <br /> / �. T� ,�� A4 2J7FMAMJJAS0ND <br /> r JFMAMJJASOND <br /> r <br /> JFMAMJJASOND <br /> ❑ I certify that the a o e hazardous material information is true and corre to the best of my knowledge. <br /> � ��lL�7G 5 �'�r<-f,/ _ �!'�� 0 9 FAdditional Inventory Sheets Attached: <br /> Signature Name(please print) Date Yes❑ NoLI <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 />