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SAN JOAQUIN COUNTY 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> f• <br /> 600 East Main Street Stockton■CA 95202-3029 <br /> (209)468-3420■Fax.(209)464-0138■ Web:www.si.gay.o>oehd <br /> Q�IF0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL I X I I I Iu EHD LOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: S C.G, PHONE: <br /> COMPANY: �r I q o.. Pte/; ar CITY: GF-meq.. <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: /-14r7;,4 CITY Incorporated <br /> Best Pbysicai Description �J <br /> Uninco orated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: y D TIME: <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> NAME OF BUSINESS: <br /> r <br /> CONTACT PERSON: ' r J PHONE: Y63- 35777L <br /> PHYSICAL ADDRESS: VG.+ CA Q'S S <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: p� <br /> CHEMICALS: {y,� <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> /�/� / } 1 n n <br />` I l tirl►r�w f w-f Cc�r ra i �r-r So�fw�- sz py boo..,, GI�x-t D+�c•!S . <br /> SITE DISPOSITION <br /> ot �:-5. <br /> ts <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />