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N_9O9' 'COUNTY �T <br /> SAN JOAQUIN COUNTY E ED �� i' <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST S��R� I�[.T�CQ !{SSIOIVER <br /> STOCKTON,CA95202-3029 MATERIALS INVENTORY DEC _,420Q$ q��@_ , 1 09 <br /> PHONE(209)468-3420 STOCKTON,CA 9520E-1809 <br /> PHONE(209)468-3300 <br /> / SAN,c&AQUIN COUNTY <br /> Part L•General Information C> <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> 62ene-dns 41 -?, <br /> mailmg Address(if different from above), Description of Business/Operation(Farm,Nurs y,Etc.): Nearest <br /> Crossroad; <br /> /l/' � 2�1e-s <br /> 7L G <br /> Emergccenc�cyy�Contact Person Phone No: Pesticide Permit/ID No:?Ih 3916 8�c� Fire District: <br /> — �z ��a �39,0 ZZ 41 <br /> Part II:Hazardous Material Information Refer to the Agricultural 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 Locations(s)on the property(e.g.in barn,NW <br /> Type of Containers corner of property) <br /> 1 — at any I time) <br /> I ct 13 &JA 0 r. JFMAMJJASOND <br /> o-oxk JFMAMJJASOND <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> I certify that the aboX4hoterial information is true and correct to the best of my knowledge. Additional Inventory Sheets Attached: <br /> Signature Name(plea print) Dae YeS❑ No❑(Return completed fo 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 />