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?oPac�N 'c0 SAN JOAQUIN COUNTY <br />`yF&SD� <br />y b.. ✓IRONMENTAL HEALTH DEPARZ�.�r',NT <br />600 E. Main Street, Stockton, CA 95202-3029 <br />P Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd �lry <br />q�/FOR�� &aP%7NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />California Health & Safety Code, Section 25180.7 <br />EHD LOG #: <br />A. EMERGENCY LEVEL II III <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Name: Phone: ( ) <br />Company: CA ( f5 M q <br />Address: City: Zip Code: <br />Designated Employee Name: F-4 Y Ml os n V WT 1✓ (, <br />Reporting Agency Name: &-q n'r. 41 e <br />Address: City: Zip Code: <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: 3 b L9"? D\j 4v `-'I b r L ..S7 0 (' 1L �Fv_j l <br />(Best Physical <br />Date of Discharge: ( Date Notified: <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: Teg b rb IN e f'�- Co 4TJ- �,,9 <br />One) <br />N V\'c) Time: A.M. P.M. <br />Contact Person: PATO L, I?r-v K Phone: (2o� `f rv6- i2$Do <br />Physical Address: 3 D 07 Q A/ y A City: 94-o L (L f-� Zip Code: qr7 0 (n <br />Mailing Address: L4 City: Zip Code: <br />E. DESCRIPTION <br />Type of Discharge: S P j 11 <br />Volume: 01 241-01 <br />Chemicals: 1) S Z sc-'_ f U e, <br />Circumstances: D o 2r- �4rC <br />F. ACTION TAKEN: C1 C41 UI2 6 0 n �At k - C � to -1 <br />oA S`-, e' <br />SITE DISPOSITION: L `i o-%) fih fi) t ell , Sbr160 vel wdl' <br />EHD 22-03 Notification of Haz Discharge <br />11/26/2007 <br />