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SAN JOAQUIN COUNTY - Lei SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS CEJ IVED OFFICE OF THE <br /> 600 E MAIN ST . AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY JAN �r 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 U 200 STOCKTON,CA 95206 <br /> PHONE(209)953-6000 <br /> Part[:General Information opgrlx <br /> SAN JOAQUIN COUMTy <br /> Business,Farm or Ranch Name: Site (include zip code): Q[sQ Phone No: <br /> Mailing Address(if different from above): / Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> PCS 8c'X /S/`I A3 SuC <br /> Emergency Contact Person: /1&,v <br /> Phone No: Pesticide Permit/ID No: Fire <br /> D District: <br /> cllJ CC /1 r' s �l L F �/ g ;G O7-167- 90 Ile S i 2- Ate/m <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 /> at anv Itime <br /> Uj�'�/ �yy_ (apo x� JF M A M J J A S 0 N D t <br /> <br /> <br /> <br /> <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> n't <br /> fy that the bove hazardous material information is true and correct to the best of my knowledge. <br /> i <br /> (T/U �ia CC/�S. i i / ` Additional Inventory Sheets Attached: <br /> Signature Name(please print) D to Yes❑ Nom <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 />