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REC <br /> SAN JOAQUDY COUNTY ' " —D SAN JOAQUIN COUNTY <br /> OF THE <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS AA 1 TURALOFFICE COMM <br /> 600EMAIN ST J/"IN 2UJ1 AGRICULTURALCOMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY POST OFFICE BOX 1809 <br /> PHONE(209)468-3420 STOCKTON,CA 95201-1809 <br /> //�� �lR PHONE(209)468-3300 <br /> Part I:General Information <br /> Business,Farm or Ranch Name. Site Locations/Address(include zip code): Phone No: <br /> Mailing Address(if different from above): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> Emergency Contact Person: Phone No: Pesticid ermit/ID No: Fire District: <br /> 2Aog er-3 7 Gvood��. -c <br /> Part II:Hazardous Material Information RefertotheAgricultural 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 /> at any 1 time <br /> / ti 19 = loo JFMAMJJASOND S .DDk ioj yyK <br /> b L8110JFMAMJJASOND 11 <br /> JFMAMJJASOND iI <br /> t <br /> JFMAMJJASOND 1tyy� <br /> `ns CD JFMAMJJASOND Il <br /> r <br /> eV *1 t03 i,-}4Yw IJFMAMJJASOND Il r <br /> Gt' IV P INDS O �w 5 ro JFMAMJJASOND IL I�c,rv� <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> I,oerti y that the above za ous material infor�m—ation is true and correct to the best of my knowledge. <br /> �1%7�0 /f� Fra C�lS . j'L-tiB-2olb Additional Inventory Sheets Attached: <br /> .at <br /> a Name(please print) Date Yes E] Now <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. 10/25/07) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />