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" SAN JOAQUIN COUNTY <br /> 0 0 <br /> y t EI*ONMENTAL HEALTH DEPART#qT <br /> 304 East Weber Avenue, 3d Floor, Stockton,CA 95202-2708 <br /> r (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> � PORa� <br /> TIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> D California Healti& Safe topy <br /> cE, ction 25180.7r[ LE EHD LOG#: - � <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (aDq) r(67-/00,6 <br /> Company: �nyIrorm <br /> Address: 3-2 s4l,& ) P-A City: S+0 - Zip Code: 15�6 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE 4 <br /> Location: 43 0 frp—} ra 'i 811IJ /1'�- ecc` / t' r County <br /> (Best Physical Descripti n) (Circle One) <br /> Date of Discharge: Date Notified: 10 Z Jos Time: A.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 4 ot " 0:szm� <br /> Contact Person: r � _ e- Ez5 Phone: (xd) Itg —4171 <br /> Physical Address: t-P3 D City: �� Zip Code: cfS 3 3 <br /> Mailing Address: $ LJ. h e U m... City: C h r-C,o Zip Code: 9S3 3 1) <br /> E. DESCRIPTION <br /> Type of Discharge: UN kJY4LJ Y'�- — S f L I Or leaK- <br /> Volume: uk \�C -Mbw r1 <br /> Chemicals: f&Ara I<-� <br /> Circumstances: D ' CA V k Y-, ss CSS m <br /> 0-pa r+ 5a , I + Qrbar\8wa+.e*- -Sarno leoCeSuHS skbWe-_ C t <br /> I <br /> F. ACTION TAKEN: RP wD ;L� l e vox-4K D4- COM40L W <br /> C,6-* na-t 6tax4 -6r nnersgL* o Hla �ntles�Z�i <br /> SITE DISPOSITION: i 0. P 5 rE e- a n 5 <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />