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�° • SAN JOAQUIN COUNTY E C �F <br /> ENVIRONMENTAL HEALTH DEPARTMENT d <br /> 600 E.Main Street, Stockton, CA 95202-3029 D <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DIS ?vs <br /> California Health & Safety Code, Section 25180. <br /> EHD LOG#: <br /> ce:u <br /> A. EMERGENCY LEVELQ II III v 3ci 713 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: (jc)(1( &M0 r)"4S Phone: 37� 5030 <br /> Company: 5+vacF,r\ nrC <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: 1✓W tJ S� r , K 4-D L (,L PVQ / CAJ or County <br /> (Best Physical Description) (Circle One) <br /> Date of Discharge: B Date Notified: l D Time: L40.,12 A� eM. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: V yNe, <br /> Contact Person: Phone: <br /> Physical Address: City: Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: S P t l L <br /> Volume: ugvmti_' <br /> Chemicals: UNmow^ M-M14f— (60wbe/L <br /> Circumstances: TV n e"e-IVD-"� Gsn 44q/^t/-j3 <br /> t� �a1rtA . <br /> F. ACTION TAKEN: ILn,t n S .t: . ��(Jv"� <br /> Ary-, ta�—L) Ar,.IIl -iA*,4 u P 14C,4 l <br /> SITE DISPOSITION: E Vag kA a'.f d 6071 n[ M h1d IG4n Clod-( <br /> EHD 22-03 Notification of Hn Dischanc <br /> 11/2612002 <br />