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SAN JOAQUIN COUNTY <br /> c <br /> VIRONMENTAL HEALTH DEPAR..rIENT <br /> 600 E. Main Street, Stockton, CA 95202-3029 5 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orWehd �•., '`.17 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCF(f <br /> California Health & Safety Code, Section 25180.7 <br /> �� EHD LOG#: 10'0 `J <br /> A. EMERGENCY LEVEL] I ) II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION 1 <br /> Name: 8 16� 4 e Lr-�y r Phone: (7&7) &6'( -0Av0 <br /> Company: ? e) y-,e t j F- n S i l ecr"n� S2/-v i Le-S <br /> Address: t.lf-JS 4r.rSyn1 Aue . City: 2o� NerAA-r'1CZip Code: c7`l' 2g <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2159 S. E L bOO '"6 r &�yL 16�-V#�Jl C�rCounty <br /> (Best Physical Description) ucle One) <br /> Date of Discharge: UrQ kn UNn Date Notified: s 3 U Time: OIL P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: RD- <br /> ,fl- � s� r -fn G, ! P S . 1'/� <br /> . <br /> Contact Person: R U&.f A N?1er'S_onl Phone: ( ) <br /> Physical Address: City: Zip Code: <br /> Mailing Address: r595 bmf- City: 6A iL 6'C/4, Zip Code: 'V36/ <br /> E. DESCRIPTION <br /> Type of Discharge: I�IALSYL 1j1SGG�ri <br /> Volume: U N k,'t ltv.n <br /> Chemicals: 2e jZon,.-, -ra U-e�j ���y (-borl za,C�i X1y1eA <br /> Circumstances: ApinaSe. 7U EW UVVUAeV�r <br /> �ersS ; n4ALt�iL/� (24 ��. �byl� A¢�c�L)�c �oaco1 i^gL HOZ. o�'g9a %5f <br /> 7�- — <br /> F. ACTION TAKEN: A t j Ir� 1 CA. 'FU 4 A �, b b eal `I �f v aLj <br /> SITE DISPOSITION: ?V4- A 1 I 9 v-' Nt/ eei <br /> O <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/262007 <br />