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owl`•'•!".. SAN JOAQUIN COUNTY <br /> AONMENTAL HEALTH DEPARTITr'.NT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd ��� �o� <br /> ' CA�IFOR�`P <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHA <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVEL: I ll III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Phone: <br /> Name: <br /> Company: <br /> Address: City: nit c✓t s Zip Code: 7 )4 w <br /> Designated Employee Name: <br /> Reporting Agency Name: — �u5,t,-w ,4lfQUOY14a-. <br /> Address: <br /> `�U l � City: Ztp Code: <br /> C. LOCATION ANDDATE OF CHARGE aT C <br /> Location: I - <br /> �OII/ �r [L� / City rCounty <br /> + <br /> (Best Physical Descnpnon) (Circle One) <br /> A.M. <br /> Date of Discharge: to � Date Notified: I Z c� Time: <br /> - At. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: 3 L <br /> �t L� � � Phone: (q(`) <br /> Contact Person: � <br /> S. U i 1 nu M City: Com.s�w C/kZip Code: 4'o 45 la <br /> Physical Address: 26 -'NT— Code: <br /> <; * <br /> Mailing Address: 4ity: Zip <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: t VIA <br /> Chemicals: ' 'l <br /> U �a�&r —1 N (f r),o r <br /> Circumstances: � <br /> tac'4¢it_ <br /> F. ACTION TAKEN: <br /> SITE DISPOSITION: n �' LDC rag <br /> Notification of Hn Discharge <br /> EHD 22-02-003 <br /> 10/2/2003 <br />