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?0 4u1 <br /> N' 0c SAN JOAQUIN COUNTY �n1F <br /> y i..VIRONMENTAL HEALTH DEPAR._ -ENT D <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> P Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DIS <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVEL I ) II III <br /> l� (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: R . A IQ>c •e_� Phone: Qoet) 337–Q`wL <br /> Company: 4 1= . <br /> Address: 11 D E3 WfanV( (vr,4 Q� QhCity: �l�Zip Code: 9-rZ2 2- <br /> Designated <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> V V-'51 ' L4!1� <br /> C. LOCATION AND IRATE OF DISCHARGE <br /> Location: JL � �"'U� / City r County <br /> (Best Physical Desc�tion) (Circle One) — <br /> Date of Discharge: t1 PL' O "'J Date Notified: S Time: j L)e 0 j C"r)P.M. <br /> D. RESPONSIBLE PERSON/BUSINESSp <br /> Name of Business: I • (0• -t E - <br /> Contact Person: 2. P ( e ao PL,' Phone:Z,9-5) ,T 77-T'XL <br /> Physical Address: City: Zip Code: <br /> Mailing Address: (( D 6 M UrdnQ( ity: 1 —Zip Code: e Z <br /> E. DESCRIPTION l <br /> Type of Discharge: be-AXIDSOTL <br /> Volume: 2, 1S1lrr.( <br /> Chemicals: 42) <br /> Circumstances: U a ei-1 reM by 1 A 7 b Sit R'w- <br /> q 1oAV— waC di( Gs <br /> F. ACTION TAKEN: <br /> SITE DISPOSITION: Re, *( j,,, e, $(,X( <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2007 <br />