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K E&i SAN JOAQUIN COUNTY <br />ONMENTAL HEALTH DEPARTOT <br />304 East Weber Avenue, 3 d Floor, Stockton, CA 95202-2708 <br />(209) 468-3420 • Fax: (209) 464-0138 • Web:. www.co.sanjoaquin.ca.us/ehd <br />p- d <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />California Health & Safety Code, Section 25180.7 <br />EHD LOG #: O6 —O�7-O <br />A. EMERGENCY LEVEL:�D II III <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Name: Bob Ne W Ma rJ Phone: (Zoq) 6 3 `) - 2 2 q / <br />Company:_S4bC4"-sj Fi►2F DePf, <br />Address: City: Zip Code: <br />Designated Employee Name: <br />Reporting Agency Name: <br />Address: City: Zip Code <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: I 1 I l _N A U�'% br, , S40o 1C �-o / Citv r Countv <br />j(Best Physical Descnphon) ircle One) <br />Date of Discharge: 10 B / 0 Date Notified: d 8 6 Time: 6 l'I A M P.M. <br />D. RESPONSIBLE PERSONBUSINESS <br />Name of Business: Z A C 1Z Y r1) R M S 1 L (,C <br />Contact Person: Leo wb&D LAm prate Phone: (2oq) !JW -40/217 <br />Physical Address: lilt N AVV DL City: S4V6 K!-vc./ Zip Code: 9SZ,06 <br />Mailing Address: City: b Zip Code: V <br />E. DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals: <br />Circumstances: <br />F. ACTION TAKEN: <br />SITE <br />A , <br />LEAK <br />NKNDW <br />Mn.0"i A. <br />!IiQ7 <br />v_q� <br />A Ile <br />EHD 22-02-003 Notification of Haz Discharge <br />10/2/2003 <br />