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E _ <br /> IN <br /> SAN JOAQUIN COUNTY ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Qm <br /> rr <br /> f N.r 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> . f. (209)468-3420•Fax:(209)468-3433 • Web:www.sjcehd.com <br /> Ll�oRa <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL I x II nI EHD LOG# -j_0 7$ <br /> B. SOURCE OF INFORMATION <br /> NAME; PHONE: <br /> COMPANY: /' Ca CITY: <br /> i <br /> ADDRESS: l 8 ( �S/? <br /> DESIGNATED EMPLOYEE NAME: Jeffrey Wong PHONE: 209 468-0335 <br /> REPORTING AGENCY NAME: S7C EHD <br /> ADDRESS: 1868 E.Hazelton,Stockton <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: p���`�yy eQ� DK CITY __.�`� co orated <br /> Best Physical Description A!.& -1-5 <br /> 5 aM—avm + f�(]�rL�I <br /> • �� !v v �! [QCT r`` � Uninco ara#ed <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: =Lz TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: �r PHONE: /�rY9 0 <br /> PHYSICAL ADDRESS: el `6n <br /> MAILING ADDRESS: V <br /> E. DESCRIPTION <br /> n <br /> TYPE OF DISCHARGE: a�� <br /> VOLUME: U 5 <br /> CHEMICALS: y <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> 0,,1-",n p/(leo� <br /> abso rh- 4o (Ar!q-l� Cc b(2- V aCCu u w_, <br /> 6, 7(9/9 tl P6 r-e r-y 5----r/0 f Corp- yq-,—Q/ <br /> SITE DISPOSITION <br /> n p/-& <br /> o �r <br /> CIC" Uf> e 4r rC� ; S <br /> 1 � ` <br /> PROP 65 Revised 07/27/12 <br />