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SAN JOAQUIN COUNTY VMSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOU S OFFICE OF THE <br /> 600 E MAIN ST GRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTOR' 2 7 ZU� 2101 E.Emhart Ave.,Suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> ,.Ul1IN GOUM y PHONE(209)953-6000 <br /> Part L•General Information y _, WICYSESM <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> 0. U,-'/n-eVe'2' 2-2,35S tV "g 0? 33I5-7Z <br /> Mailing Address(if different from above): Description of Business/Operation(F rm,Nursery,Etc.): Nearest Crossroad: <br /> e3 Ss ,fi. , u, /11 i1.../ `,� gve <br /> Emergent Contact Person: Phone No: I Pesticide Permit/ID No: Fire District: <br /> 2A1lf4 J�' 252z 3 oqs d <br /> Part 11: Hazardous Material Information Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below and their re ortablequantities) <br /> Material Name DOT a 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 Itime <br /> T rp JFMAMJJASOND <br /> lJ ( P NG1e c.> (� JFMAMJJASONDa� <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND 2011 <br /> M� Y.pflify that the above It ardous material information is true and correct to the best of my knowledge. AGR. COMM. -STOCKTON <br /> / 2 ory Sheets Attached: <br /> Signature Name(please print) Date Yes❑ N <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 />