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�o co SAN JOAQUIN COUNTY <br /> a <br /> N ENvlRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 1 <br /> ILE <br /> COPY <br /> (209)468-3420 •Fax: (209)464-0138- Web: www.co.san-joaquin.ca,us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: <br /> I <br /> A. EMERGENCY LEVEL II IIT <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: i t Phone: Q41 )_ U�.,190LJ� _ <br /> Company: .0- w'c wwkS <br /> Address: ve e• City: c Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Will e 11134 6. 61(vitqLA ti I City Coun <br /> (Bed Physical Description) I (Circle ne <br /> Date of Discharge: 1 au Date Notified: 1111,9164 Time: 6 15% M P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: �l S <br /> Contact Person: mgqAS 100 M& Phone: <br /> Physical Address: loll City: Zip Code: _� o 1 <br /> Mailing Address: U. 1 Q ilq 'u Yl City: Zip Code:- I 1hV S o <br /> E. DESCRIPTION <br /> Type of Discharge: ; <br /> Volume: o <br /> Chemicals: ¢, <br /> Circ m tances: E ¢Ifs V 1 <br /> r5 <br /> F. ACTION TAKEN: <br /> NMI, <br /> c S ; <br /> c +Jtu v v� • I <br /> SITE D14S SITION: <br /> Cd <br /> Q; uc 0jV9YjA <br /> f t� Sir nC to l h hUMl <br /> K. w J r vl Y iy <br /> EHD 22-02 3 <br /> 10/2/2003 Notification of Haz Discharge <br />