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�o•`�'' y•co SAN JOAQUIN COUNTY FIL,E <br /> �OENvIRONMENTAL HEALTH DEPARTMENT <br /> PY <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/ehd <br /> q� PO�a <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: b 5- 03 <br /> A. EMERGENCY LEVEL H III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> i�� s P� <br /> Phone: <br /> Name: S <br /> Company: <br /> City: Zip Code: <br /> Address: <br /> Designated Employee Name: lJl►'l <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: w 4 n� LO / Cit y or ount <br /> (Best Physical Description) (Circle ne <br /> Date of Discharge: o <br /> Date Notified: Time: ,C)05 a.mt. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: ���' V C q U/1'1✓ <br /> Contact Person: i Ve, e Dr- f^ Phone: ( ) <br /> Physical Address: i(�I S C(2 ql V r���V-Ntity: LLQ Z1t�-- D2- Zip Code: '7-7,703 <br /> Mailing Address: �°f-btity: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge:' <br /> Volume: Me r <br /> Chemicals: `� � <br /> Circumstances: e�n���— W Y�'1. 1Ad Q- [A fl n' <br /> F. ACTION TAKEN: G 10-" <br /> SITE DISPOSITION C tN r\ <br /> Notification of Haz Discharge <br /> EHD 22-02-003 <br />