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�. . SAN JOAQUIN COUNTY. <br /> FILE COPY <br /> a as ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, P Floor, Stockton,CA 95202-2708 <br /> (209)468-3420-Fax:(209)464-0138 • Web:www.co.san-joaqum.ca.us/ehd <br /> F P <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: 0O <br /> A. EMERGENCY LEVE I II <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: eom) 13 7 7y <br /> Name: Q LI^ r n �Y - <br /> Company: m Z L4�M'E S (V'AL V-P� 20G <br /> ` City: L Zip Code: <br /> Address: v- <br /> vj <br /> Designated Employee Name: a� <br /> Reporting Agency Name: ' <br /> Address: <br /> City: �v� Zip Code: <br /> � <br /> C. LOCATION AND DATE OF DISCHARGE 1 / _ Cit r County <br /> Location: ` U� t 7� �N cle One) <br /> (Best Physical Description) <br /> � 5-2 A.�t. <br /> Date of Discharge: <br /> Z-7 Q Date Notified: L2-11 b Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: N T�jPhone: (2010 g y�" 8.?6 y <br /> Contact Person: �� V S -� City: � L��d`-� Zip Code: g�24Z <br /> Physical Address: N Zip Code: <br /> Mailing Address: — City: <br /> E. DESCRIPTION <br /> Type of Discharge: C�ObO <br /> Volume: <br /> Chemicals: V M 3 ,151 c Ulw n <br /> A-LC l a CAI <br /> Circumstances: <br /> F. ACTION TAKEN: <br /> SITE DISPOSITION: ��"'� <br /> Notification of Haz Discharge <br />