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SAN JOAQUIN COUNTY SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENTAGRICULTURAL HAZARDOUS �'�� _ OFFICE OF THE <br /> 600 E MAIN ST ( �j 9 AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E.Emban Ave.,Suite too <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> PHONE(209)953-6000 <br /> Part[:General Information <br /> Business,'Farm or Ranch Name: // Site Locations/Address(include zip code): Phone No: <br /> /ilk ¢./dS e?/ Gf7et <br /> Mailing Address(if different from abov : Desc 'ption of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> res wk arm . (/irl4e42111Wj 4", ldaa�i-. <br /> Emergency Contact Person: Phone No: Iresiicide Permit/ID No: Fire District: <br /> /Diaac3 a9 X3169-�37 3 -io adG.•` <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 Sin 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 /> 3e- MAMJJASOND �• � ie,5 /� <br /> JFMAMJJASOND <br /> 1993 Q ap <br /> 0/ ��Q JFMAMJJASOND U 1-5-2-0 Al O�Q I7X:rl <br /> elc <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> ❑ I�the abo a azardous material information is true and correct to the best of my knowledge. p <br /> � �d//�� �1�� d ! Additional Inventory❑ Sheets ttached: <br /> Signature Name(please print) Date Yes NO <br /> (Return completed forms) 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. I0n5/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />