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"- SAN JOAQUIN COUNTY Wr_ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> • 600 E.Main Street, Stockton,CA 95202-3029 <br /> TdeAvxe:(209)468-3420 FaaG(209)468-3433Web:www sjgov.org/ �t <br /> NOTIFICATION OF HAZARDOUS WASTE DISE L!7=V <br /> California Health& Safety Code,Seedon 25180.7 <br /> EHD LOG#: DY$ <br /> A. EMERGENCY LEVEL: 11 III <br /> (circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Qo 'L- Phone: (2ol) 53� <br /> Company: r 46 UA Z Mg�- <br /> Desi tedEmployee Name: �� Zip Code' <br /> �a <br /> Reporting Agency Name: <br /> Address: City: Zip Code: _ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ID11 SN by C� i OL Dr , S P p G V N#*J i un <br /> (Best Physical Demi ion) a Oma) <br /> Date of Discharge: LlA.X Date Notified: 4 Z 3 Z Time- <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: C p r� P rDDUCj `� <br /> Contact Person: o►t� A k L Phone: Oil)Sg2 3 <br /> Physical Address: 1#1,1 4 p r• City; g_ Zip Code. <br /> Mailing Address: P= D !jb L) _City: ShL 1L tin Zip Codef <br /> E. DESCRIPTION <br /> Type of Discharge: GL mrdl t,l #A�Aj. <br /> Volume: 5!sb5§10#4K M h Se(,&D <br /> trp►I ��ti.ti oafs ha[1- <br /> Chemicals: r, 1 C iu^14. rAX, <br /> Circumstances: _A }eyIe.l C 04jy L j2'A +%v- A Pastel, R w� <br /> pe4 s i j on aL A h0k-,. _. <br /> F. ACTION TAKEN: t?A�► S a-t� IZ!'S p n G , <br /> SITE DISPOSITION: '^- A'L r!n CQ <br /> ERD 22-03 Natificatkm of Haz Mchup <br /> l ln&=7 <br />