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SAN JOAQUIN COUNTY WED SAN JOAQU[N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY JAN 112009 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> I <br /> SAN JOAUUW COUNTY PHONE(209)953-6000 I � <br /> Part I:General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): l P�bp ne No• <br /> bo 66L <br /> j� 37 `FZ� '96ys7- t�D <br /> Mailing Address(if different from above): Description of Business/Operation arm,Nursery,Etc.): Near st Crossroad: <br /> bc.-A4 CLI s-a, rN Z-Isc ' P'C� <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: <br /> <br /> <br /> <br /> <br /> <br /> + <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND DEC2 2 2008 <br /> JFMAMJJASOND SAN JOAQUIN COUNTY <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> ❑ I certify that the above hazardous material information is true and correct to the best of my knowledge. <br /> .Adb + w . Her ,- )4X)/00 Additional Inventory Sheets Attached: <br /> Sigure Name(please print) Date I Yes❑ No[—] <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. 10/15/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />