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SAN JOAQUIN COUNTY <br /> s ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weberl,Avenue, 3'd F1oor, Stockton, CA 95202-2708 <br /> r (204)468-3420•Fmv (209)464-0138- Web:vN^v.co:san joaquin.ca.us/eh 'OPT <br /> O P T <br /> - '1 <br /> C�CpF' ILE C <br /> p'Rc��P :� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safe Code, Section 2�X <br /> California�Iea tY ,�. <br /> if <br /> EHD LOG#: <br /> A. EMERGENCY LEVEL II it <br /> (Circle One) <br /> B. SOURCE OF INFORMATION phone: {2 ) RS3 u2 <br /> Z <br /> owSy-I <br /> Name: �k : - 0rt NI �k�;t✓S '��I'S ��' <br /> I Company: Ste' u���] Zip Code- � Z b <br /> Address: —v a Ci <br /> Designated Employee Name: > S.A&-t– i r n M.aA,� <br /> Reporting Agency Name: Ste" 11 � ,,KG/-O-n Zip Code: els <br /> Address: 36c'L 711 -L City: <br /> i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Co <br /> t4-2, 00 <br /> rr <br /> ' (a• / Cit o unty <br /> Location' <br /> � LO4V � [ � ii (Circle t <br /> cri tion <br />� (Best Physical Des p ) <br /> l�[� q.�i. P. S. <br /> �(,� b Date Notified:'{ .2I 2 6 aLj Time: <br />�. Date of Discharge, i <br /> D. RESPONSIBLE PERSON,[BUSINESS <br /> I? <br /> 6A ,51/lar I R Af- 5& <br /> t Name of Business: A AM PN �� 11 Phone: (q 16) Tt �7s <br /> Contact Person: 42J¢� `� <br />{ City: Zip Code: <br /> physical Address: •Sp3 Ci I S�yc,n�M�Lv Zip Code: _- <br /> Mailing Address: ZL Y5 <br /> brd• ry <br /> E. DESCRIPTION I} <br /> g MtiS�, . ro <br /> Type of Discharge: � <br /> Volume, <br /> 241�1 Chemicals: 1 <br /> Circumstances: <br /> r ^ �a , <br /> F. ACTION TAKEN: C l�,R�i <br /> SITE DISPOSITION: .� f <br /> 7 <br /> } Notification of flaz Discha ge <br /> ik <br />