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o Doal I" pSAN JOAQUIN COUNTY IZ Z 11 D <br /> a l-` ENVIRONMENTAL HEALTH DEPARTMENT <br /> r` 600 East Main Street Stockton CA 95202-3029 ' <br /> (209)468-3420•Fax.(209)464-0138 Web.www.sieov.or¢/ehd <br /> ORS <br /> NOTIFICATION OF.HAZARDOUS WASTE DISCHARGE. <br /> A. EMERGENCY LEVEL EHD LOG# — 71-4 <br /> B. SOURCE OF INFORMATION <br /> NAME: MA PHONE: 6 <br /> COMPANY: ,,,�,, CITY: S - <br /> ADDRESS:. 0404) <br /> DESIGNATED EMPLOYEE NAME,: - PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: 3d2g A f CITY C Inco rated <br /> Unincorporated <br /> DATE OF DISCHARGE: I 3D <br /> DATE NOTIFIED: �.) .), TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS _ <br /> NAME OF BUSINESS_: - G4 ) <br /> CONTACT PERSON: `Ir .- _ PHONE: <br /> PHYSICAL ADDRESS: ?. Naft Dn• <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: .� � A.vYvIY1�) Lo— <br /> CIRCUMSTANCES: O✓ ' <br /> F. ACTION TAKEN <br /> fz*i'W PW <br /> e.cus�, ;✓, 75 N vs o (, 5eordcUt <br /> rv��!►�u ,�,y�. ���t,�td � � sem, -� � ��- �- <br /> SITE DISPOSITION <br /> ER RECORD MODIFIED Rm=d 05/01/2007 <br />