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SAN JOAQUIN COUNTYf <br /> ,., b-„.RONMENTAL HEALTH DEPART�,,.,ST _� D <br /> 600 E.Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:wwwsjgov.org/e r i <br /> �fFO ; t <br /> NOTIFICATION OF HAZARDOUS WASTE DISC k7:: J~ <br /> California Health& Safety Code,Section 25180.7 <br /> EHD LOG#: -(97_ <br /> A. EMERGENCY LEVEL/ I ) II III <br /> �--� (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 2A'`{ VLvNJ P LU E_ Phone: Qtj) W 68'Gf 64(g <br /> Company: S4PJ TD,A 42 v i^ 60, P A n <br /> Address: (POO F . I''I Al►J '9t, City: 940-616'An j Zip Code: 2,e2_ <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: `�S N• vv �? r2rj 2h / Ci oroun <br /> (Best Physical Description) & (Circle <br /> Date of Discharge: V N 0"A Date Notified: bt' if <br /> 0b��llb aD. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 6 erort b our” -m— 5f e c _ p2E '{4 <br /> Contact Person: berm t� crl'kA1_ Phone: V_n Lt6Y- 3,cjs�_ <br /> Physical Address: 32 3 2 S Vw4 City: Zip Code: -5,E2! <br /> Mailing Address: k U City. u Zip Code: U <br /> E. DESCRIPTION <br /> Type of Discharge: Le A <br /> Volume: S jun, <br /> Chemicals: &ASD 1 )'vt- <br /> Circumstances: buti As T /V►6 04'L.. <br /> /_Li9Li-L N <br /> F. ACTION TAKEN: U N h e A— (pry Nb V�_ (yKol/ -i, <br /> 1 S G�rSrl. <br /> SITE DISPOSITION: V o M ` � MSL <br /> ` C w L <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2007 <br />