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SAN JOAQUIN COUNTY am ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3'a Floor, Stockton, CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> COPYCalifornia Health & Safety Code, Section 25180.7 EHDLOG#: oto-o4� <br /> A. EMERGENCY LEVEL Il III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Sko NDN Mef�402/ Phone: (2,n q((3, SJU 2 <br /> Company: \14 (" (iG <br /> Address: _2141 ( n) A-y`/ t�r i City: 600 Zip Code: q-V2,/6 <br /> Designated Employee Name: _ Sa►hZ Al 4,49ale-, <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 29 Ll l)4'U Se Or, l S IV-L V— City r County <br /> (Best Physical Descrition) --"(circle One) <br /> Date of Discharge: -7136106 _Date Notified: O Time: y M P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: W i 014MS "("ArNV- L1 n/9- <br /> Contact Person: M 1 Lk44'L W t bl 1 q hv( Phone: (904 qtfc(' S6/3 <br /> Physical Address: ' 114'7�7 T1 life, LVA -rS OrCity: a b,& fG I`uN Zip Code: S204 <br /> Mailing Address: P. 0, 6 OK to 12,(& City: IC} Zip Code: "-lSZOi� <br /> E. DESCRIPTION <br /> Type of Discharge: -ro Co.-JCtOke— C0,1 �41n rA?*¢— <br /> Volume: 5" S !0 411 bNq <br /> Chemicals: A S-o I f—w—, PVaA- <br /> Circumstances: ti V er reAP 6 ✓L jF W v) P M Fi V <br /> F. ACTION TAKEN: �' y I i Gt e4+ aj 0.0 ro-c I (/'k., <br /> SITE DISPOSITION: A'6501+& f tirvr CBA J-JM w f- <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />