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01D /7?� <br /> SAN JOAQUIN COUNTY — '� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST JJANJ AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2012 POST OFFICE BOX 1809 <br /> PHONE(209)468-3420 STOCKTON,CA 95201-1809 <br /> �� SAN JOAOUIN COUNTY PHONE(209)468-3300 <br /> Part I: General Information OFFICE OF EMERGE <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> 3l Lietj- "FAemS I-?9l6 15 N 69 Cfemeas (15 a04-7s9- a26 <br /> Mailing A ess(if different from above): Description of Busine s/Operation(Farm,Nursery, Nearest Crossroad: <br /> Emergency Contact Person: �, Phone No: 2pt Pesticide Permit/ID No: Fire District: <br /> �,,G aoa— 7S4 3 q p �f p 4�7 CJen+e.�lg <br /> Part II:Hazardous Material Information Refer to the Ag ricultural Hazard Material Worksheet for the materials that should be listed below and their reportablequantities) <br /> Material Name DOT# Container Container Sin 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 /> 1710 I4q313+0e3t70oGL JFMAM JASO D <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> RECEIVED <br /> JFMAMJJASOND <br /> JAN 31 201Z JFMAMJJASOND REGEIVED <br /> MM. STOCKTON JFMAMJJASOND IAN 2 6 Z012 <br /> JFMAMJJASOND <br /> JFMAMJJASOND AGR. COMM. - STOCKTON <br /> ffIccrtify that the above hazardous material information is true and correct to the best of my knowledge. <br /> ytJVV�_ yam/ Sf kill'N ICS L l e,IL.L 7— 1-2, Additional Inventory Sheets Attached: <br /> Signature o Name(please print) CV 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. 10/25/07) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />