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Impel SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3'd Floor, Stockton,CA 95202-2708 ` ®4P <br /> r (209)468-3420•Fax:(209)464-0138 - Web: www.co.san-joaquin.ca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: O -0049- <br /> A. <br /> OD4}'A. EMERGENCY LEVEL"�J II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: il-t C— "t a r1 rky- i J C5L-\ Phone: 961) 3-37 • b 3Y <br /> Company: {v-La fgfrf(�M <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 V A44 <br /> Location: 11966 A: Lia l-er SruwaVhQ..itii-z�) Cit or unto <br /> (Best Physical Description) (CircleCircle One <br /> Date of Discharge: 1 Y1 Z-00 -7 Date Notified: I I k c' 7 Time: /%d© A.M. e.M <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: AY-L0 ffi"1 Ptl- <br /> Contact Person: aIn J` 1 A71N car S av� Phone: (2clo 3 <br /> Physical Address: 1 w 1 ewe,v b lr City: W0066/,b.' Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: 5 Qt <br /> Volume: L4 an I(tsh <br /> Chemicals: to-l/tw. I- <br /> Circumstances: a ( u by S+- t Ar- So' 1 t=d 4-. <br /> f-( LA ' ( �Q -WHIN <br /> i (y,-el 4k--t n cL8v-e (Ltu-)L-j - <br /> F. ACTION TAKEN: '�i(k O)P_V d +n%t4- - 4 t --il 61 bSca.i0--e' - Cy' <br /> S bva za C/k a lk S v�cA Si-e <br /> SITE DISPOSITION: /V N 1 <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />