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SAN JOAQUIN COUNTY d -- <br /> 'y ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> :. 600 East Main Street Stockton-CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138 - Web:www.sigov.orl_/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG ? ,o <br /> A. EMERGENCY LEVEL LX EHD LOG# -� <br /> B. SOURCE OF INFORMATION <br /> NAME: �> 4- 4PHONE: —505-0475 <br /> COMPANY: 1 ? �T CITY: j <br /> ADDRESS: -2— ? <br /> Alte- <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: I j---or hJ —D�—Tm,,- 1.2,oS CITY Incorporated <br /> Best Physical Desertion <br /> Unincorporated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: TIME: <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> NAME OF BUSINESS: f �-- �- <br /> CONTACT PERSON: PHONE: 6oZ- <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: <br /> CIRCUMSTANCES: ^ jy. <br /> I <br /> F. ACTION TAKEN / p <br /> ��j �t�tlP�`av�z� � h�.--�t� �P.c.►^�` � Gr71v� A.Sf�C- <br /> �,�- I�!3� �-' t,,� �2"3-.�8-, G lde-►-M�, .,..�s �'�.rs�..",�' -,� 2 :�f-r� ._._ . <br /> SITE DISPOSITION / <br /> i <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />