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SAN JOAQUIN COUNTY r SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS REC12008 <br /> VELA OFFICE OF THE <br /> 600 E MAIN ST GRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY POST OFFICE BOX 189 <br /> OCKTN,CA <br /> PHONE(29)468-3420 // ULLI STPHONfi(2 9)468-03300 09 <br /> Part I:General Information I b <br /> Business Farm or Ranch Name.• Site Locations/Address(include zip code): O� M RG NCY SERVICES Phone No: <br /> as�c/ /S70 i1/ ��ss <br /> Mailing Address(if dilfertnt from ab e): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> dI-n� l ' r <br /> Emergency Contact Person: Phone No: Pe nide Permit/ID No: 39 9 Fire District: <br /> yes Q -�69- Z -/b-390 �35ZdG�d` c <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(s)on the property(e.g.in barn,NW <br /> Type of Containers corner of property) <br /> at any I time <br /> Q �I <br /> vii 3 160G JFMAMJJASOND JQd <br /> 4 k zeoG <br /> FJFMAMJJASOND —�13 13F MAMJJAS0ND a it <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND 55�� <br /> JFMAMJJASOND ® !S <br /> JFMAMJJASOND NOV 2 6 200 <br /> JFMAMJJASOND SANJOAQO1MM pDl <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> I c rtify that the a ove hazar o m rial information true and correct to thehpst of my knowledge. <br /> ��nn// �/✓��/✓�jJ /1 Z ® Additional Inventory Sheets Attached: <br /> Signature Name(please int) Dae Yes❑ No❑ <br /> (Return completed form 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 />