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�o cp SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 4 East Weber Avenue 3`d Floor Stockton CA 95202-2708 <br /> 0 T 19 <br /> ,p (209) 68-3420•Fax:(209)464-0138 ■ Web:www.co.san joaquin.ca.us/ L U <br /> y fioR <br /> NOTIFI ATION OF HAZARDOUS WASTE DISCHARGE <br /> alifornia Health & Safety Code, Section 25180.7 <br /> EHD LOG#: OCA--D 6 <br /> A. EMERGENCY L VEI II III <br /> (Circle One) <br /> B. SOURCE OF INF RMATION <br /> Name: MRr2w___ L 1 L-L-- Phone: (2c'i ) b 4`1-2-0`t o <br /> Company: ►u \ S '\Arm L,',A' <br /> Address: ly'1'1 ttc- Lk`^"5 'DR • City: Zip Code: ''SIzRo <br /> Designated Employee Name: N(A <br /> Reporting Agency N e: 5�3 L E 4 D <br /> Address: 'jo ?_ AA- ' " " Cit 5�u` "J <br /> y: Zip Code: 95 1-0-L- <br /> C. LOCATION AND ATE OF DISCHARGE <br /> Location: .905 �Lo l4 M1LC- b"T n't \-A^1 At"t'J / City or ount <br /> (Best Physical Description) (Circl <br /> Date of Discharge: �7`''L o 6 Date Notified: l0 2�0� Time: �� A.M.. P.M. <br /> D. RESPONSIBLE P SON/BUSINESS <br /> Name of Business: u.t kyw5 TA <br /> Contact Person: i4v'k4 1.1`-L Phone: (tog) (_`{g toy o <br /> Physical Address: 4 ? ZTILut LE,--LE,--1'>'' 1' City: Sroc-�3 Zip Code: '1'5 Zc�6Mailing Address: x 6 k2fe. City: f�'TtA�'- Zip Code: 5'susb <br /> E. DESCRIPTION <br /> Type of Discharge: S 1 �- <br /> Volume: u-2.Sa <br /> Chemicals: V 0 C-'9 C'A L>,o c— <br /> Circumstances: WLC-cE Pcc.,.0enir2 (AkkL Kc.. <br /> 'To lug '�•�� w�t.c �r try n) URx-►4 'D. <br /> F. ACTION TAKEN: LC-Av--l14^ <br /> (7F F <br /> SITE DISPOSITION: Vy,i14 Q'Lw eP---r4 6V4►_C_&`S A-"e .A-c-- <br /> ajX '�nr�15 l5 IVt7 lJor.C�E^a- N C'a,O 4-9-1) <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />