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o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT a`vslo <br /> , D <br /> 304 East Weber Avenue, 3`'Floor, Stockton, CA 95202-•2708 <br /> (209)468-3420■Fax:(209)464-0138• Web:www.co.san-joaquinca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> C(D [PY <br /> EHD LOG#: oma-o5D <br /> A. EMERGENCY LEVEL H III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: S 1,-\4 wN Me," U7.4 Phone: (20'1) °IG13 - 5-66,2- <br /> Company: <br /> (06 2Company: V A I e-r o L P <br /> Address: 210 1 Ny br- ___City: 1114 Zip Code: SZ�b <br /> Designated Employee Name: S 4 n- 46 &AA <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: V V br. �-Orj / City r Counjy <br /> (BeA Physical Description) Circle One) <br /> { <br /> Date of Discharge: 11 -7104,. Date Notified: Time: - 2-07 n.t I <br /> M. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: Bhr- 9- �� Pe,+U lelUI"rl <br /> Contact Person: TLnem Yt e 2 Phone: (2ol -7 7-3— 57 K D Z <br /> Physical Address: I LI 56 (7 Sk. City: M VQ—LzJ Zip Code: "'757 Li <br /> Mailing Address: P- 01 a o X City: M&-i�GJ Zip Code: G1j� <br /> E. DESCRIPTION <br /> Type of Discharge: To Co rJ S WV«Mh FUM <br /> Volume: wil&rte <br /> Chemicals: �,e_ L t~U&A— <br /> Circumstances: _j2D er-g+v#,, P,,_Q,�eymeAt P_t p-x L- _ <br /> F. ACTION TAKEN: S 12° Y1 C UP b! j f l i <br /> SITE DISPOSITION: A16gyrn b- Bn AnMQ1 <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />