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.SAN.TOAQUIN COUNTY <br /> 2 cy ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton, CA 95202-2708 <br /> ` (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.us/ <br /> fI <br /> COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: OS- O�3ta <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: . Phone: ) — 5 <br /> Company: ;,lc'- <br /> Address-,_ (.(oYl �l',.ALWead eIo City: 'AnLY�tv,- Zip Code: 95- 2-(17 <br /> Designated Employee Name: At c,(,.0-,- �-e- <br /> Reporting Agency Name: a 9 U 1'1,4 K_.B'Uvt- �/%f dyt rw�• K2..Q (J <br /> Address: 36q `L G,kke-A- City: 10C k'� Zip Code: !!� 1-2,6 2 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: y`1 t C)AA1— a=— c 1C L / ity r County <br /> (Best Physical Description) (Circle One) <br /> Date of Discharge: 0,5- Date Notified: _�- - S Time: °° A.M. <br /> D. RESPONSIBLE PERSONBUSINESS ^,� <br /> Name of Business: U AUko L /►t-d� i��t 6-- <br /> Contact Person: ��I,(.i � � � Phone: ( ) <br /> Physical Address: I C afd City: d6(9— Zip Code: I !��-t <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: o,i t2 ckrua z<-J oni fl2 Uy �,lJr <br /> CE <br /> F. ACTION TAKEN: a - <br /> SITE DISPOSITION: lD C� vw ria c,� <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />