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U <br /> *ro SAN JOAQUIN COUNTY <br /> (pQD� MONMENTAL HEALTH DEPART T <br /> SP1 East Weber Avenue, 3dFloor, Stockton, CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138 • Web:www.co.sanjoaquin.ca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> DCalifornia Health & Safety Code, Section 25180.7 <br /> D EHD LOG#: 07 'I 4g <br /> D <br /> A. lMERGENCY LEVEL:OI II �IITn <br /> (Circle On 0 (J <br /> B. SOURCE OF INFORMATION Q <br /> Name: 6C4 1&14 Phone: 000 <br /> Company: /wa <br /> Address: jr -/5it CitVL, 'QAAIu. Zip Code: l / <br /> Designated Employee Name: �Gli9LP2�erg <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: zl , Aire . J)4c� 0 / CitVLr County <br /> est Physical escription) ---(Circle One) <br /> Date of Discharge: Gvn� Date Notified: /Z / d Time: loo ^'M' P.M' <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: !—T� /` '�Ae �, <br /> Contact Person: Phone:go�) • 1-71/ <br /> Physical Address: City. Zip Code: <br /> Mailing Address: /OZY Cf/ /c -/c '� I City: S Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: w� <br /> Chemicals: <br /> Circumstances: ,Clic Q oa oat .� < �4.cAu-o -�a �a— <br /> �Qtc.�Otst...-�-u <br /> F. ACTION TAKEN: - l t✓lGe G'�/•�w���b � <br /> SITE DISPOSITION: <br /> 46 <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />