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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT RM <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.ustehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7COPY EHD LOG <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Sk4yuN Metj twz4 Phone: (2801) ON 3 - 5662 <br /> Company: VAIs-r-a Imp <br /> Address: -2-101 N4"--'Y b r-, City: 5f V G 14�-y r4 Zip Code: 67TZ 0 b <br /> Designated Employee Name: 4-ne, 4.5 c_ <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2(1 14 ( N A,VV br. � <5Iy& (G�u+--1 / City r County <br /> (Bes Physical Description) Circle One) <br /> Date of Discharge: 10L Date Notified: _Time: 9 2-1 A.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name ofBusiness: Fhl-H9- 4 P240 101)t*1 <br /> Contact Person: TF10V 1t9 &bme2 Phone: (2v4_jZ3— �'-[D2 <br /> Physical Address: ' 1456 6 Sk City: M errGanl Zip Code: �1 S3 q! <br /> Mailing Address: P. O. (3 o Y --130 City: Zip Code: 61n !�t b <br /> E. DESCRIPTION <br /> Type of Discharge: 'rp Co a 4-4guTK n <br /> Volume: I 0_0 59'UI eNC <br /> Chemicals: i ' 'r L fry eA - <br /> Circumstances: 19 D 6� q } vn -,< of Q,,)I p N CA f- <br /> F. ACTION TAKEN: up F4-f,1 If C , <br /> SITE DISPOSITION: A�'sorbnl p Is f d~''�"S—i Gin l tiMn�otil- <br /> s 0we_T;' d d v� 6 7 V A-C 'r rvV10L <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />