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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT � <br /> 600 E.Main Shit,Stockton,CA 95202-3029 <br /> Te%pbone:(209)468-3420 Fax(209)468-3433 Web.www.sjgovorw re`-F- RD <br /> T-- . <br /> NOTIFICATION OF HAZARDOUS WASTE DIS E )� l i <br /> California Health& Safety Code,Section 25180 �j� <br /> EHD LOG#: - DY$ <br /> A. EMERGENCY LEVEL: II III <br /> (Circle Orae) <br /> B. SOURCE OF INFORMATION <br /> Name: Rom VDpt't- Phone: (tory) 953- (aZe6 <br /> Company: E 11►J LLi t F to L <br /> Address: <br /> cfty: Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 21 f N�v f� i� 6r , S�p c V-No J / i un <br /> (BW Physical Description) a One) <br /> Date of Discharge: Z3 I- Date Notified: Time: <br /> +Wb wM x <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NameofBusiness: COO-) PrDDUC)� S <br /> Contact Person: #- n k L Phone: Oil)Sl-(?-8233 <br /> Physical Address: j V L j City: c IL Zip Code: q SW(b <br /> Mailing Address: _P, D- 3h)6 (, 12q City Sfut.lL{v, Zip Code: Q4 <br /> E. DESCRIPTION <br /> TypeofDischerge: _g0L)ban-1n'(, (`0tt1( <br /> Volume: S t+b a 6+( it 1h ge( cpt {.hit K ory� owl i <br /> Chemicals: 1 C iur-t4,-Idro)(;04} <br /> Circumstances: A IQV4,1 Con�jl1, on +I-#- 4-4AV. PA ltpk� R o,-,, w. <br /> QOS i i bX+- 1"IL J.„ A hp/<, <br /> F. ACTION TAKEN: eAn rN C) L-C, <br /> M4Aart�(L, W� � lac irG� �n prDtziS 01 -YI e tnAAirt uFuiA <br /> J <br /> SITE DISPOSITION: <br /> EM 22-03 NodBcaum of Hn Dacbwr <br /> 1!!262007 <br />