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IL o <br /> SANJoAQunN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 600 East Main Street Stockton • CA 95202-3029 <br /> (209)468-3420-Fax:(209)464-0138- Web:www.sjgay.org/ehd <br /> cR�iFo���P C <br /> NOTIFICATION`OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ixglIfII EHD LOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: tai PHONE: <br /> COMPANY: } CITY: �Y} <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: Tkys, TrArl\ PHONE: 450 <br /> REPORTING AGENCY NAME: <br /> ADDRESS: Y SOL ti a <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: 144q r,' ��rt,I �Y �n Incorporated <br /> Best Physics!Descr pt `�"t`'� 1I VIL 1)p <br /> in i rsa h9tm Uincomorated. <br /> DATE OF'DISCHARG S L f <br /> DATE NOTIFIED: & 4. (C7 TIIWE: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: rr 11 <br /> CONTACT PERSON: r PHONE: l Q <br /> PHYSICAL ADDRESS: It ! y Zp s <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: <br /> CIRCUMSTANCES: 15 <br /> F. ACTION TAKEN <br /> 5�, gym ,, hut- a . fire w 646%• ,re twL� � FJ <br /> 4 6� n �s�L � � <br /> � oil + m dvw s� F.O ga, 4&4, of ��- V.tq&h - fa,�k <br /> Vv`ill W smfpeoL a$ • sl2 WV- wit l e- deie rm"n0,�,}�'- if- I{- is V�01f• <br /> 2°Cr <br /> SITE DISPOSITION <br /> m.. Jaw r6`n-Vl *0+iu, Bch nip} aq- V von , oil a� o av ,p{ d►`� vt� <br /> wiL! ?u,►mV &w+ 4+,a G- ers 3rd 4w sie& 96055 d_ 6F- <br /> fu; 1, *[a m '50 E 1 ��ll be removed , Far,d,�,� AL1 leo <br /> qWIV + s+brw+ Aqjj • UfAOvP V4411 ee A4W, #bday . <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />