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SAN.TOA UIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3"Floor, Stockton, CA 95202-2708 <br /> e (209)468-3420 ■Fax:(209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> L,.po <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health. & Safety Code, Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: TH6 futOR-0 Phone: (�.A ) 9416 - <br /> Company: <br /> 416 -Company: <br /> Address: S3P i —C't STDC460 N Zip Code: 4 520 2- <br /> Designated <br /> Designated Employee Name: 72A*u a;rn G t <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 530 si.✓w ST / City or County <br /> (Best Physical Description) (Circle One) <br /> Date of Discharge: 2lzkl 0 b _DateNotified: oG Time: '30 P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: TWE A "90 <br /> Contact Person: a-y- Phone: (uA) V36 1 <br /> Physical ical Address: 510 �w � ST _ - City� �b <br /> &�-ftA Zip Code: ey5Z <br /> � <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: `rage- le r_o^ <br /> i <br /> F. ACTION TAKEN: NO-r- (tea/' C_a.W- A-;, LIP t4A1Cf <br /> f <br /> SITE DISPOSITION: <br />.i <br /> i <br /> EHD 22-02-003 ]Notification of Haz Discharge <br /> 101212003 <br />