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�o o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL'HEALTH DEPARTMENT <br /> 304 East Weber Avenue,-3d Floor, Stockton,CA 93202-2708 i <br /> ' (2D9)468-3420 Fav{20�)464-0138 Web:w*w.co.san joaquin.ca.us/ehd J <br /> c•�. ON�OFHAZARDOUS E <br /> WASTE DISCHARGE <br /> ' <br /> - , TIFICATT . . <br /> California He & Safe Code, Section 25184.7 <br /> D EHD LOG#: <br /> A. ' EMERGENCY LEVEL II Iii z <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Scam eaL M U-uj _Phone: (?j <br /> Company: R '-52 t vA.P Q5I- w <br /> Address: t City: ice? 0#9 Zip-Code: 793'16.1 <br /> 17 Designated Employee Name: <br /> Repotting Agency Name: /V✓,f-DM'Y1 �i •'� 1f�°T/V V f <br /> Address: ►y1�iN ST City: �S j��.�¢-Tb-/y - . Zip Code: _ qS_7.a_2 <br /> C. .LOCATION AND DATE OF DISCHARGE, <br /> ''Location: 7 7 L L h .. -.-1 . Ci o nt <br /> a <br /> (Best Physical Description) (Circle <br /> 'kZ 01- Date Notified: 17-1 b*7 . Time: <br /> Date of Discharge:.! <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business:sS X51 M 19-L& -- . <br /> Contact Person: �b HN Phone: ( ) <br /> Physical Address: "? (Aity: t-Imi aP Zip Code' 4--5334 <br /> :. ?� City., � . <br /> Mailing Address: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: - <br /> 77 <br /> Volume: ,41W 1 <br /> i LAST 10 <br /> Chemicals: <br /> Circumstances: M4&L&A le7- <br /> F. ACTION TAKEN: - AS t.J sJ�GL <br /> � G • <br /> SITE DISPOSITION: <br /> TW v- ro f erre OW <br /> Fun 22 02 003 Notification of Haz Discharge <br />