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SAN JOAQUIN COUNTY - SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL HAZARDOUS AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY DEC 21010 POST OFFICE BOX 1809 <br /> PHONE(209)468-3420 STOCKTON,CA 95201-1809 <br /> SAN JOAQUIN COUNTY PHONE(209)468-3300 <br /> Part I: General Information nmr.F OF EmERGENCY SERVICES <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> i ing Address(il different from above): escn bon of Busine /Operation Farm,Nursery,Etc.): Ne t rossroad: <br /> l0 'C- <br /> Emergency Contact Person: Plibne No: Pesticide Permit/ID No: 1 S s Fire District: <br /> Fart If:Hazardous Material Information Refer to the Ag ricultural 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 /> Type of Containers corner of properly) <br /> at any Itime <br /> f-3 ��W=- —e <br /> 2_ JFMAMJJAS0ND j� <br /> 1 <br /> s �L JFMAMJJASOND l ` L <br /> JFMAMJJASOND Lwill <br /> C <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND D <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> I certify that the above hazardous material information is true and correct to the best of my knowledge. SAN JOAQUIN COUNTY <br /> -' &e 0`a s If l� Additional Inventory Sheets c led: <br /> -diaFafiff-e- ' Name(pleffc prix 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 />