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� <br /> SAN JOAQUIN COUNTY Zoo SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS a ` OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY JAN 16 2009 POST OFFICE BOX 1809 <br /> PHONE(209)468-3420 STOCKTON,CA 95201-1809 <br /> PHONE(209)468-3300 <br /> Part I:General Information �� SAN JOAQUIN CCY OUN VICES <br /> Business,Farm or Ranch Name: P Site Locations/Address(include zip code): Phone No: <br /> /I / Q9 a a y6 o <br /> Mailing Address(if different from above): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> kot /y/9", /,""y / 7,S"r239 furor— fsck <br /> Emergency Contact Person: - Phone No: Pesticide Permit/ID No: Fire District: <br /> o•.J �ucclac% o W 0 - C 0 « Hoke/V&A, e <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 any I time <br /> 3 /Op(7 `Opp 1FMAMJJASOND <br /> <br /> <br /> <br /> FMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND ms(C)511 <br /> JFMAMJJASOND DEC 1 <br /> JFMAMJJASOND SANOAaom OO' <br /> JFMAMJJASOND <br /> ify that tl above hazardous material information is true and correct to the best of my knowledge. <br /> t . <br /> 1)n ����i CSS' ( a �/ O a Additional Inventory Sheets Attached: <br /> Si ure Name(please print) Date YES❑ No�p <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 />