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V SAN JOAQUIN COUNTY - EI V E�AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST pE q AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY � 20� <br /> 7 POST OFFICE BOX 1809 <br /> PHONE(209)468-3420 STOCKTON,CA 95201-1809 <br /> y//7 79' � J�YW PHONE(209)468-3300 <br /> Part I:General Information �l/h J <br /> Business,Farm or R ame: Site Locations/Address(include zip code): Phone No: <br /> � `r`rTl- 9 <br /> Nailing AWdress(if different from above): F Description of Businessoperation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> AbVAt�(Ply-Ca <br /> Emergency Con act erson: Phone No: Pesticide Permit I ID No: Fire District: <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 /> 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 I time pp <br /> 2 JFMAMJJAS0ND I <br /> LZ® 3 abJ'FM AMJSASOBD <br /> F M <br /> r l Q t^uu4 JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND NOV 15 2011 <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> certify that the above ha z rdous material information is true and correct to the best of my knowledge. <br /> lily l C <br /> Lg Additional Inventory ee Attached: <br /> El Np& <br /> e Name(please in[) Date Yes(Return completed form(s) to the San Joaquin County Agricultural Commissioner. Do not submit fees with inventory. Fee pa ent will be <br /> collected based on invoicing by the Environmental Health Dept.) (rev. 10/25/07) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />