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1109 <br /> SAN JOAQUIN COUNTY '�® SAN JOAQUIN COUNTY - <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY MAY - 7 2010 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> SAN JOAQUIN COUNTY PHONE(209)953-6000 <br /> Part L•General Information JFFICE OF EMERGENCY <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> Mailing Address(if different from above): Description of Business/Operation(F rm,Nursery,Etc.): Nearest Crossroad: <br /> oz- <br /> �7$ �oclf e 62 /�OE� /LC RX <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: FireDi rict: <br /> '0`7 r uJ 6k60-H02jQ <br /> Part II:Hazardous Material Information Refer to the Ag ricultural Hazard Material Worksheet for the materials that should be listed below and their reportable quantities) <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 /> p /` at an I time <br /> J 1, O .700 ,p JFMAMJJASOND # <br /> <br /> <br /> <br /> / <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND D RIR=Sg <br /> JFMAMJJASOND APR 1 5 2010 <br /> JFMAMJJASOND SAN JOAQUINCOUNTY <br /> Arm <br /> JFMAMJJASOND <br /> ❑ I certify that a ove hazardous material information is true and correct to the beset of my knowledge. <br /> /1 jk/4! /�}''T/f}J "/ — /10 <br /> /10 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 />