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�p SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> � : (209)468-3420■Fax.(209)464-0138 ■ Web: www.co.san-joaquin.ca.us/chd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: 0(J-- 0< <br />` A. EMERGENCY LEVEL 11 III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: IGNb Y /K 'L( <br /> Phone: 20 b06— S-yo <br /> Company: k&4 �,LC e <br /> p _ <br /> Address: 11 S4I S- Uwji of 0-12 City: ,44'+iLiZKJ � Zip Code: � <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE AP N 21 -7 6 cbgS _ <br /> Location: b D &MXe, 4--m- AAANG / Cit Count <br /> (Best Physical Description) ircle One) <br /> Date of Discharge: 1�+i_Y�y Kjoj Date Notified: /Z / 6 Time: �:�(3 A.M. nm <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: DPhone: (eon 82 3 Z S yq <br /> Physical Address: 79-71_ 6. Dis+tl q_r.►iN Or-.City: AAAf J r=44 _Zip Code: S 13 6 <br /> Mailing Address: City: Zip Code: F <br /> E. DESCRIPTION <br /> Type of Discharge: Z116- <br /> Volume: 116Volume: <br /> Chemicals: yJ.►S �. ��y rt�,v <br /> Circumstances: ",I— P-1, <br /> F. ACTION TAKEN: h__!' P l v S6 <br /> N P -c, i ' <br /> O' WA ten.-. <br /> SITE DISPOSITION: <br /> EHD 22-02-003 Notification of Haz Discharge ; <br /> 10/212003 <br />