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SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DER ,&TMENT <br /> ' 600 East Main Street Stockton - CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138 • Web: %ww.sjgov.or /g ehd <br /> a��FOR� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Co <br /> A. EMERGENCY LEVEL X i uI IEHD LOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: S n�� aAt( PHONE: f1� <br /> COMPANY: z CITY: Vj�wTU�o- JDU <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE 1 <br /> LOCATION: <br /> Best Physical Description $. !77�/ i�h�-�-f CITY /�11N.�hC(-1 X Incorporated <br /> Unincorporated <br /> DATE OF DISCHARGE: �,,� <br /> DATE NOTIFIED: �j� l S �/1 TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: M&4-w -O eA-1 C O <br /> CONTACT PERSON: PHONE: <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: 1"I e t, I�''i�t�, -e6u CA F 3 17 <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: ) <br /> CHEMICALS: 4, 4p t6�� <br /> CIRCUMSTANCES: S <br /> F. ACTION TAKEN <br /> CO.rn. h A.1,P- /2XMsex. C' v &4j-le 1 <br /> ,alta e -1� �x wry �f -4 v c <br /> SITE DISPOSITION <br /> pr�Ell <br /> H� /l�t/ti�-!� �.c� �f����3 Zo/l G{��/l.o�_-�v� war,�Y l�►•.�n..� <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />