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Pp Ufry <br /> SAN JOAQUIN COUNTY <br /> y E., ✓IRONMENTAL HEALTH DEPARi..IENT <br /> L p <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> d9m Telephone:(209)468-3420 Fax. (209)468-3433 Web:www.sjgov.org/eh <br /> �/FORS � O VC <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR E <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: 0 )_r01q <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF,INFORMATION <br /> Name: J 12 . 1 A 0L S Phone: (5&'1 27 L-'L7�3D <br /> Company: E � (Cc-L, LAS <br /> Address: A 9',( c'1 R oke ( r.M R"w City: Pq. ANtDw 11 Zip Code: 90_72 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> / City r County <br /> (Best Physical Description) Circle One) <br /> Date of Discharge: U l'J'V_^t3 ws/ Date Notified: 2 Time: U A.M. P.M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 'S4 . JJ �a ;ECvtr1 d 7 fu rc l' k� <br /> Contact Person: M f LQ., &f-`1 i Wn Phone: Qagj C a_-, 3<t <br /> Physical Address: JIG D4t "7 6 City: >�(ilG�e-. Zip Code: c/ � <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: Cr V_ <br /> Volume: <br /> Chemicals: (9AQ 116/c J @SQL Qn ZG,4_, <br /> Circumstances: &o j r-Q S J ( lr( r <br /> OLy �--a r 1 kJ r( _� I f V S 'r ✓�p M rr 7i'1'1 <br /> F. ACTION TAKEN: u N r0+�i"d <br /> b i S Glak 2 � <br /> z <br /> SITT;FFTDISPOSITION: ( CQ4'AAX LL �, ULum�r <br /> A m ink <br /> �r tre S ff L <br /> M � M l iu tic UIZw 1.J <br /> EHD 22-03 Notificah n of Ha Discharge <br /> 11/26/2007 <br />