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-0 J JJ <br /> f <br /> SAN.J�OAQUIN COUNTY L04� <br /> �. 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N { <br /> 600 E.Main Street, Stockton,CA 95202-3029 Telephone: (209)4b$-3420 Fax: (209)468-3433 Web:ww�v.sjgov.orgNOTIFICATION OF HAZARDOUS WASTE DISC <br /> California Health & Safety Code,Section 25180.7 <br /> EHD LOG#: � <br /> A. EMERGENCY LEVEL& II . III . � � <br /> (Circle One) a r 4 j <br /> B. SOURCE OF INFORMATION <br /> Name: "-j Phone: 001 <br /> Company: S l M IQ 16 <br /> Address: -1-7PIBJ R 4,. City: Zip Code: 3 G <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: i0 U'1 bl/�� Yi 1,01-ttvQCl Collip <br /> (Best Physical Description) rrcle One) <br /> Date of Discharge: 0'l f Date Notified: Time: It i Ot <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business' 12_ �; j tA jO 16 <br /> Contact Person: Phone:�A g§ <br /> Physical Address: 5-0k - City: Zip Code: <br /> Mailing Address: City: Zip Code: -7Y 33 b <br /> E. DESCRIPTION <br /> Type of Discharge: lA tk- <br /> Volume: <br /> Chemicals: <br /> tF <br /> Circumstances: A 4 S 0 (A 0 Lt, - <br /> Q!` <br /> F. ACTION TAKEN. SoTL W <br /> 1 <br /> SITE DISPOSITION; 0 KJ t <br /> EHD 22-03 Notiftca6en of Haz Discharge <br /> 11/26/2007 <br />