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i <br /> a <br /> • �4 A <br /> ` SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209) 468-3420-Fax:(209)464-3433- Web:www.si4ov.orglehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL © 1 ❑ II ❑ III EHD LOG# <br /> B. SOURCE OF INFORMATION �r <br /> NAME: "Yi ryz PHONE: ��t —Zq p <br /> COMPANY: San Joaquin County Environmental Health Department aTY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. 7[ <br /> DESIGNATED EMPLOYEE NAME: S PHONE: q6t 1L9i <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Best <br /> LOCATION: <br /> I/?r �y C uD .7 J't��"^ CITY �j�p�iEy� In rated <br /> Desai tion L ❑ Unincorporated <br /> DATE OF DISCHARGE: Z. <br /> DATE NOTIFIED: TIME: �- <br /> D. RESPONSIBLE P RSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: }p- PHONE: <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: 4t C—hVlrow•a.�rL 5N .O Gzv x <br /> E. DESCRIPTION I z 55-6 � r^ecvr0� -A 9377 `X' <br /> TYPE OF DISCHARGE: d <br /> VOLUME: `IO ©O PO., <br /> CHEMICALS: r /^ lr�� i <br /> CIRCUMSTANCES: L -n,Q�¢„ Spm t7y —jv�tsttr,.. I�Svrz J)ae- <br /> F. ACTION TAKEN J / f��A`�- <br /> SITE DISPOSITION <br /> Revised 00/02/12 J Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />