Laserfiche WebLink
0 T <br /> 4Z <br /> P°"'" SAN JOAQUIN COUNTY <br /> ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cP.. (209)468-3420•Fax:(209)464-3433- Web:www.siaov.oro/ehd <br /> �G%FORS <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x I ❑ II ❑ III EHD LOG# -/ �-► <br /> B. SOURCE OF INFORMATION <br /> NAME: $. PHONE: 0q S j;-- 73 <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: a-e .,- PHONE: dU C1 Cf <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 /> LOCATION: CII.J� 1h rbc \� 1 <br /> "1.J� 7 \�� �,l„ y�J ( ❑ incorporated <br /> Best Physical Ctl\k \\\rrr'111Wtr) CITY <br /> Desai tion t0 Ck., ) � � Unincorporated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: 1— © —( TIME: aAll <br /> - - D.---RESPONSIBLEPERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: i uz( PHONE: J S O(e Aja <br /> PHYSICAL ADDRESS: �� `�� \` Agiv xAtitiviii fN /A C1 37 <br /> MAILINGADDRESS: SCuNA <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: CL5,1 t r�Q <br /> oc. \JCnc7ctQ Cmid Sci6, % W+ADrn oX- \nc� <br /> CIRCUMSTANCES: 0 <br /> c ! ( �n c <br /> F. ACTION TAKEN <br /> CLWA S til C���rpSS - �G�CIG`pr \U�n. �Utu} Ce �lcc cl <br /> AA4 bo(.k on �LA ot•a CL . S3'henk Sf(�cvQt � QbSu(b 3 itiP <br /> 9CtSakanc 4 ''flip abSo(beq a W\U 54-6-L <br /> SITE DISPOSITION <br /> 0cx1 05 TGC\'fd Cjo MGl t2, <br /> \' O / Cl ��'JUr�J{1 t 5itc <br /> eco 01 n Lo \ . �,\\ 0. su � L)1L1 S D�r\� y� <br /> `.>eA U: v W\ 1 PrP C c bS a J ajYi U►� �I <br /> h -2-.'Oow C h ' u b <br /> Revised 11/03/14 Page 1 of 2 NOTIFICATION OF HAZ WASTE ISCHAR E <br />