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✓ ©9 <br /> SAN JOAQUIN COUNTY SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDousRECEI ED OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E.Farhan Ave.,Suite 100 <br /> PHONE(209)468-3420 2 $ PHONE(0209) A 96006 <br /> Part L•General Information -P i I37 SANjOAnjjiNrnijKrry <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip cod���EMERGENCY SERVICES PM1one No: <br /> V" tp ca t,' " 4617Z- <br /> Mailing Ad ress(if different from above): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> ©. 3 / I ^T �2�"2®C -� tit lam( <br /> Emergency Contact erson: Phone No: Pesticide Permit/to No: Fire District, <br /> Part Il:Hazardous Material Information Refer to the All ricultural Hazard Material Worksheet for the materials that should be listed below and their reportablequantities) <br /> Material Name DOT p 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 Itime <br /> <JF AMJJASOND <br /> �� !?—� JFMAMJJASOND (�� tr <br /> JFMAMJJASOND <br /> yl fC Q 0rca :7 5 JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> I certify that the a�haze ous material information is true and correct to the best of my knowledge. n' <br /> r D <br /> � Additional Inventory Sliet�ttached: <br /> nature 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.) RECEIVED (rev. 10/15/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br /> DEC 1 1 2008 <br /> AGR COMM.-STOCKTON <br />