Laserfiche WebLink
° q lN':so • SAN 3OAQUIN COUNT)• Q <br /> Ll D <br /> n +ti. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y I 600 East Main Street Stockton• CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138• Web:wanv.s- ov.or ehd <br /> CIFOR� O P�� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR <br /> A. EMERGENCY LEVEL I X I EHD LOG# <br /> I-0 5 <br /> B. SOURCE OF INFORMATION <br /> NAME: (Q Cjd <br /> 11 II PHONE: a3rj��j')b <br /> COMPANY: Q(�` - S 'I W C CITY; <br /> ADDRESS: 30� Ka �rt� <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: W 3L D n Ve— COY Incorporated <br /> Bal Physical Cxcriprion <br /> Uninco orated <br /> DATE OF DISCHARGE: ?J as b <br /> DATE NOTIFIED: a a a TIME: lj <br /> D. RESPONSIBLE PERSON/BUSEMs <br /> NAME OF BUSINESS: Pour,-(-, <br /> CONTACT PERSON: PHONE: D'B �0 3-7 0 <br /> PHYSICAL ADDRESS: Now Dr6Vo <br /> MAULING ADDRESS: lry� <br /> E. DESCRUMON J <br /> TYPE OF DISCHARGE: ,Rit, J1 N Gr <br /> VOLUME: N3 <br /> CHEMICALS: <br /> CIRCUMSTANCES: �,� ggj�Qr (znnec,flonf222).. <br /> F. ACTION TAKEN <br /> t ai Def4- 4-b pt u,- Wme Cm p�p5 to s#vp f <br /> SITE DISPOSITION <br /> /P{NI <br /> ON l <br /> �Vl✓I(27Pr <br /> � r V 1 4u oUE �i/Y1Z —s Sl(� a I VISiGt& CP vt^P 4 <br /> �`aVlk fu ptwyeA 0V+ Utyn+w eyrlcer va rPfRir_,,CaK t.,e <br /> • <br /> ER RECORD MODIFIED Revised 05/012007 <br />