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San Joaquin County <br /> Environmental Health Department <br /> 1868 E Hazelton Avenue, Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br /> Public Works Waste Pickup and Transportation <br /> i. Date: 5/12/2017 2. C00043456 <br /> 3.Time: 0930 4. EPA ID M CAS111111039 <br /> 5. Transporter Registration #: 6148 <br /> 6. Reporting Party: ❑PW ❑SO ❑CHP XOthers: <br /> 7. Waste Pick-up Address: <br /> 8. Destination: 7850 S R A Bridgeford, Stockton, CA 95206 <br /> 9. Containers 30. Waste <br /> # Quantity Size Description <br /> 1 14 30 oz. Plastic bottles with fungicide residue <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> ii. Emergency Contact <br /> Environmental Health Department: (209) 468-3420 <br /> 12. Special Instructions and Other Comments <br /> DTSC took responsibility for the containers, will be picked up 5/18/2017 by PARC Specialty <br /> 23.Signature: <br /> 14. Inspector Name:Jamie Lima is.Title: HMS 11 <br />