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D0 6600e" <br /> SAN JOAQUIN COUNTY <br /> EN v1RONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 FILE p �o� <br /> r • (209)468-3420•Fax:(209)464-0138• Web:www.co.sanjoaquin.ca.us/ehd ( <br /> oft <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: O(o - 09 1 <br /> A. EMERGENCY LEVEL& II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: aW&CA NW1.✓t Phone: (4el ) gF1.11tiS7 <br /> Company: 9A- 1'}DI y <br /> Address: City: Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE /�l <br /> Location: gjti Pa4�it L• 1 � Ck b15ul / G)f or County <br /> (Best Ph t 1 Description) Circle One) <br /> Date of Discharge: 1,JV low Date Notified: Time: P.M. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: All Ct <br /> Contact Person: Phone: (tA) (Lo j- j,Sr4! <br /> Physical Address: City: Zip Code: CK1A <br /> Mailing Address: City. Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: clJ <br /> Volume: <br /> Chemicals: A4AA (or <br /> Circumstances: t tf eOWL <br /> F. ACTION TAKEN: 14 6vmvWh mJ o <br /> OmAl k Nu w <br /> Iv � a S . o c ao( booV�nsr <br /> ' loinZtt A a 0. . <br /> SITE DISPOSITION: <br /> EHD 22-02-003 Notification of Hu Discharge <br /> 10/2/2003 <br />