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` • SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE C0PY <br /> } 304 East Weber Avenue, 3 d Floor, Stockton, CA 95202-2708 <br /> (209)468-3420•Fax.(209)464-0138 • Web:www.co.san-joaquin.ca.Us/ehd <br /> t t <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: - 0(0-7- <br /> I <br /> A. EMERGENCY LEVEL II <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> i Name: Phone: Qoq ) q[4_�,�5cj <br /> Company: i v vi <br /> Address: l4 City: . L� n Zip Code: 4IS3 0 2 <br /> Designated Employee Name: <br /> Reporting Agency Name: l <br /> Address: I City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: go rLa . "V el / Ci or County <br /> (Best Physical Description) (Circle One) <br /> i <br /> Date of Discharge: o t Date Notified: .5 1A 0.1 Time: I cfS .0 p.m. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: rcmN1 fills ra.A Ey's K44"j <br /> Contact Person: Pho : k(1 4) wi r <br /> Physical Address: by ci,h City: %gj*D Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> t <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: at.41 <br /> F. ACTION TAKEN: tnc nac wt 66 6Lk t <br /> t � <br /> v- e <br /> tJ i ih. N � Jivuvlwtyt� <br /> SITE D SPOS TION: <br /> Iritaavc�ut�c 4w�ikt C�ew,n*url -IS fw�,.h�P � <br /> i <br /> EHD 22-02-003 <br /> 10/2/2003 Notification of Hu tTccharon <br />