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I y�f-7 <br /> SAN JOAQUIN COUNTYCV /�D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS RCv \N G OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY DEC 211 ZD1D POST OFFICE BOX 1809 <br /> PHONE(209)468-3420 STOCKTON,CA 95201-1809 <br /> PHONE(209)468-3300 <br /> Part I:General Information <br /> SAN JOAQUIN COUNTY <br /> Bus' s,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> z r4 iL^ 223 5S �v9 t333/s 7z- <br /> ading Address(if differea roro above): T 1 f(:,4,, ,� QA, Description of Business/Operation(FArm,Nursery,Etc.): Nearest Crossroad: <br /> �S S ,{mo w �, �J ' Pe-weg-� <br /> Empst{rncy Contact Person: Phone No: Pesticide Permit/ID No: Fire District: :f <br /> Xl//\) 333 S Z 4.e 6 b. C04 <br /> Part II:Hazardous Material Information Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below and their reportablequantities) <br /> aterial Name DOT# Container Container Size Max.Number Circle the Months On Site Locations(s)on the property(e.g.in barn,NW <br /> 1 Type of Containers corner of property) <br /> ` ' / at an 1 time <br /> q RtiK— JFMAMJJAS0ND "- <br /> <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND �oy�7I�7� <br /> JFMAMJJASON incisS �1 <br /> JFMAMJJASON NOV 2 2 2010 <br /> JFMAMJJASOND ANJOAQUINCOUNW <br /> LOW <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> n( ertify that the above hazardous material information is true and correct to the best of my knowledge. <br /> /r! * 0'pu /.'e J t"M e.-,e Z ` �22- /C1 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. 10/25/07) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />