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�° oG SAN JOAQUIN COUNTY <br /> E. IRONMENTAL HEALTH DEPAR. ENT <br /> 304 East Weber Avenue,3`d Floor, Stockton, CA 95202-2708 <br /> 4 a r• (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ehd <br /> 0 <br /> TIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Californiab1liljt Section 25180.7 <br /> 0� EHD LOG #: ]-b� <br /> A. EMVRGENCY LEVEL 11 III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: PAGtP V4L/a Phone: (9") %�77-- 772S- <br /> Company: Vee 0 E 2 R D'J:r <br /> Address: City: Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE O�DISCHARGE <br /> Location: 61-121 ' P A&s r G 41.c. J cs�k{ / City r County <br /> (Best Physical Description) ircle One) <br /> Date of Discharge: 5 ) Z /D-7 Date Notified: 2 10-7 Time: 6.03 A.M.CM) <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: S4�e k.,W`7 <br /> Contact Person: E I ev'pri- Phone: far,)x'72 9150 k/26 <br /> Physical Address: (o''/2S '_�ir-Lw City: S ><uL �F-ti Zip Code: 9J-2o-) <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: SP i d� <br /> Volume: 6 Salla�s <br /> Chemicals: [94 So 1 t <br /> Circumstances: (ZeIeq,s-c.- Jt_e. fh CU31vngeL e�/o <br /> F. ACTION TAKEN: _EMp(oy40J p(44,� FAn a . <br /> l)sr4, ALfo-16,14- bo✓ 77 04-f>� p•34 r, CIoSt� <br /> -Fle.1��led l v<�re1� <br /> SITE DISPOSITION: 1Ct <br /> EHD 22-02.003 Notification of Haz Discharge <br /> 10/2/2003 <br />