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SAN JOAQUIN COUNTY C�� Q - ED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT GRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST ,���•..,i 1 AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 2U1U MATERIALS INVENTORY 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 L STOCKTON,CA 95206 <br /> PHONE(209)953-6000 <br /> Part L•General Information SAN JOAQUIN COUNTY <br /> Business,Farm or Ranch Name: O rte Locations/Address(include zip code): 17P/S wY Phone No: <br /> Q IL 1 e rc i ��K m �7 7/�E f/��y 4�f3 qs��� d/ej rnwfs tea— 759-�2a! <br /> Mailing Address(if different from above): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> fro L` x leo�f C°l evu>°k>Fs C'r�. 9s�a7 Gni u��/vu� lr� • ���� s ,' /mss �' , <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: Fire District: <br /> 5 f'�U�N C free c ao9- `ls"�3acl <br /> �3,Y-10-31?-0,Voe17 L° le n+e-w4-s <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 N 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 /> 2775 to JFMO@JIAS0ND f7715E WM SQ 1N13/1KA! <br /> A 2-75a- 1 b Q JFMAMJJ(9DOND Il71Sr SI,O <br /> MA) pri-ki;W 22, S ?144ic. 21J G JFMAMJJSOOND .SAAIr— .4k'Wr Sl,e <br /> GjZ,qm0X0w' A'791 ;L1/2Gi} 4 JF CSOCT&nD ND 5f+arG kLou*- u 6n <br /> dew�-11 b 1 )1099, a6- [LS. I JFMAMJJASOND SAt++G bOwe ) US�6 <br /> t'_z> ( aa3 S.1-fie( Opp JFMAMJJASO g f}w,Q A botrti /11/ 5tt�to <br /> ✓ �GI^j Ia03 5 }eel Il9Oo JF JJASOND M<- <br /> P's e. 1RQ3 yt1 9:6- i6s I JFMAMJJASOND SPC 1 / I sOaft SLt <br /> (�$ed el'/ q l F;q S-Ftel aTSfrA( JFMAMJJASOND <br /> t/ P/j 1 c t l — � • <br /> ao ue/ I9�4 rRMIC $00 FMAMJJASOND sk <br /> JFMAMJJASOND t It t <br /> oFSI}o <br /> ❑ I certify that the above hazardous material information is true and correct to the best of my knowledge. <br /> Additional Inventory Sheets Attached: <br /> Signature Name(please print) Date 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 /> JAN 15 201" <br /> AGR. COMM. - STOCKTON <br />