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D <br /> �° a °o SAN JOAQUIN COUNTY � <br /> G <br /> ;< `'� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708f <br /> oQ �P (209)468-3420•Fax:(209)464-0138 • Web:www.co.san joaquin.ca.us/eh <br /> GipoR l ` (Q)PLD 7 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE U <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: Oc2 <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION (� <br /> Name: 9.4 Phone: ('vo) O 310- j <br /> Company: <br /> of <br /> Address: 6III'm City: NZip Code: !) <br /> Designated Employee Name: 1/lz.1 fidl�, le. <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: '690"0 64� `-S?tT4r- �C40( `' / (Citlyr Count <br /> (Best Physical Description) 1 CC�ircle One) <br /> Date of Discharge: i(•l� Date Notified: W1717wll Time: 345f A.M. <br /> D. RESPONSIBLE.PERSONBUSINESS �; N.aw� <br /> Name of Business: /&dtT-c-k cI c 9 � . <br /> Contact Person: Q+"fc.eA a4AA-Sea,.tl", Phone: d) S49C ed <br /> N,ewA-' k+h7st l Address: 4a-•-JCity: 5 c4,0 -1a Zip Code: S� <br /> Mailing Address: 166 City: 9!57X71b A+ Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: '/C �-��►'�- <br /> Volume: <br /> Chemicals: f <br /> Circumstances: dO4 aV'--d <br /> Q.h-g0 <br /> F. ACTION TAKEN: <br /> SITE DISP SITION: <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />