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of <br /> SAN JOAQUIN COUNTY SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUSOFFICE OF THE <br /> 600 E MAIN STE 7WC 7 AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> PHONE(209)953-6000 <br /> Part 1:General Information J <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> 0X)9 13IX6 P L LZ0V SZ3 WOO <br /> Mailing Address(if different from above): Description of Business/Opera a(Farm,Nursery,Etc.): Neases[ rVk 1 1� <br /> p a <br /> 77 Emergency Contact Person: - Phone No: Pesticide Permit ID No: Fire D' rict: OA$ S e F <br /> ki5llsv — 09 0 o H R <br /> Part IT: Hazardus Material Information Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below and their reportablequantities) <br /> Material Name DOT q 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 Itime <br /> JFMAMJJAS9ND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND rL <br /> JFMAMJJASOND E tv E 1r <br /> V <br /> JFMAMJJASOND DEC <br /> AL 16 <br /> JFMAMJJASOND <br /> AGIR <br /> JFMAMJJASOND t <br /> ❑ I certify that the above hazardous material information is Aa <br /> andcorrectto the best of my knowledge. <br /> �+ f (d St (..._ iK1 O jZ"/2,— // Additional Inventory Sheeeets�ttached: <br /> Signature Name(please print) Date fres❑ NoLR <br /> (Return co leted 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 />