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SAN JOAQUIN COUNTY VEiSSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUSt 9 OFFICE OF THE <br /> 600 E MAIN ST APR 1 9 2010 AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 Q�NN STOCKTON,CA 95206 <br /> Offlc EMERGENCYSERVICER PHONE(209)953-6000 <br /> CF <br /> Part 1: General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> ! lza P o SAI -&/o <br /> Mailing Address(if different from above): Description of Business/Operation rm,Nursery,Etc.): 'g st Cros road: <br /> Emergency Contact Person: PM1one o: Pesticide Permit/ID No: Fire Dis ic[: <br /> l Fits S,� � , <br /> Part II:Hazardca4s 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 1 time <br /> �/ t JFMAMJJA N <br /> JFMAMJJASOND <br /> L7 / QQ JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND L" C E ! <br /> JFMAMJJASOND APR 1 3 2010 a <br /> JFMAMJJASOND `� ` <br /> ❑ Iceerrttiiffy that the above hazardous material information is true and correct to the best of my knowledge. <br /> oti /� ex�0FdOY,* Additional Inventory Sheets Attached: <br /> Signature Name(please print) / Date Yes❑ NoM <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 />