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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209) 468-3420 • Fax: (209) 464-3433 • Web: www.sigov.orq. /ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A, EMERGENCY LEVEL 91 [] If ❑ III EHD LOG# j � 7� <br /> B . SOURCE OF INFORMATION r <br /> NAME: Tma PHONE: C�_. <br /> COMPANY: San Joaquin County Environmental Health Department CITY., Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave. , Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: �a1 (.`-'�r' �n .�� CITM '-f J�,- ❑ Inco orated - <br /> Best Physical "1, �v r ` Vv <br /> Description "� n q�, ry I ^9 j!kUnincorporated <br /> DATE OF DISCHARGE: I� O I' 6 - V kt UY r4 <br /> DATE NOTIFIED: �� • �, �'• TIME: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: PHONE: <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: <br /> E . DESCRIPTION <br /> TYPE OF DISCHARGE: lega <br /> t U�p o ad adx <br /> VOLUME: <br /> CHEMICALS: G(60 0 <br /> vet Ur' � n)ac stmt E� vtK- rtimo -fvu(VA <br /> CIRCUMSTANCES: � Cn . i r�t�ii <br /> F . ACTION TAKEN L I <br /> CKca Ul �a i[ uvt w �wtovtx f wets p� c brtr t tf�f o (ark U FfeT <br /> +�o t A !AZ e��� � �t �� to <br /> SITE DISPOSITION <br /> Ate, MR O2 pLcji:eoC wikr td 0O ' 0-F 93 t t'o Local &Vr ;ic�tnl <br /> POCA Ar fv ivle- at Ored�c A r.kmnup . <br /> Revised 08/02/12 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />