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�4utk.�o SAN JOAQUIN COUNTY <br /> r' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,37 r,Stockton, CA 95202-2708 <br /> 209)468-3420•Fax:(209)464-0138• Web:www•co.san�oaquin.ca.us/ehd <br /> 'qGl Fib V <br /> VV KATION OF HAZARDOUS WASTE DISCHARGE <br /> p California Health & Safet)' Code, Section 25180.7 <br /> 3 � - Y <br /> EHD LOG#: 7 <br /> A. EMERGENCY LEVEL <br /> �I II � <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Ohos Phone: 49 <br /> Name: <br /> Y{� <br /> Company: ' CGL- City. Zip Code: <br /> Address: G <br /> Designated Employee Name: J yr r <br /> ReportingZip Code: <br /> Agency Name: D �- <br /> rd C� <br /> Cit <br /> Address: �l/�l Gy 3 ODr y: <br /> C. LOCATION AND DATE OF DISCHARGE �orG ��"csf t�� iYia-r)t�C� <br /> (Tc,s-f- <br /> e <br /> rdrl� r COuntY <br /> Location: <br /> f 7U�1 cS n 5-f- i`�`)(2a']a'GGQ✓ (Circle Ore} <br /> (Best Physical Description) <br /> Date of Discharge: ^ Date Notified: <br /> IQ-'a2 1~0'�; Time: <br /> D. RESPONSIBLE PERSON(BUSINESS <br /> Name of Business: G� WQQ4 4M 1r fav � <br /> Phone. (7v7) 5 2 3 . Q <br /> Contact Person: p �� _Zip Code: <br /> Physical Address: 3 3 20 jn�us�'i� lYi'>/� City: ��City: Zip Code: <br /> Mailing Address: <br /> �. ,DESCRIPTION <br /> Type of Discharge: 1? <br /> Volume: <br /> Lt,bNct-- 85 all �s <br /> Chemicals: y�,Z halt 1' <br /> Circumstances: <br /> F. ACTION TAKEN: T <br /> _ 0 <br /> SITE DISPOSITION: r <br /> Notification of Haz Disct <br />