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SAN JoAQ UIN COUNTY FILE . COPY <br /> NVIRONMEN'F�-HEALTH DEPARTMENT <br /> ` 30 East Weber Avenue,3`d Floor,Stockton,CA 9520�2�2c ous�ehd <br /> (209)4 w <br /> 8-3420•Fax:(209)464-0138 • Web:ww.co.san joaq <br /> NOTIFICATIONH <br /> OF AZARDOUS WAST 2�ISCHARG <br /> California Health & Safety Section <br /> Code, <br /> 80.7 EPID LOG#: v'q ' d 1 O <br /> Eacl <br /> VE <br /> A. EMERGENCY (Circle one) <br /> B. SOURCE OF IN FOpMATION Phone: (,I((,) 2-lb- 2,1LILL <br /> Name: toxo to <br /> an N f Zip Code: 6117 <br /> Company: f n CAJ City: <br /> Address: a`'t <br /> Designated Employee Name: <br /> Zip Code: <br /> Reporting Agency Name: <br /> City: <br /> Address: <br /> LOCATION AND DATE OF DISCHARGE Cit r County <br /> C. c ,3 6• ", {^ � �S ircle One) <br /> Location: U (gest Physical Description) <br /> A Vit. P�t <br /> t� ,� >r� Date Notified: <br /> 2 � IL Time: 10%26 • <br /> Date of Discharge: <br /> D. <br /> RESPONSIBLE PERSONBUSINE C b'Z� ; ` ��� Co, �6- 2�6L <br /> Name of Busine s: 11 <br /> �1 i ems! P A'L C Phone:���) 2 r <br /> Jc�,vr ll c- _Zip Code: <br /> Contact Person: �� ^_i City: R <br /> ��� � <br /> Physical Addre s: City: Zip Code: <br /> Mailing Address: <br /> E. DESCRIPTION n V Loco K,4,-5 <br /> Type of Discharge: e41A r'"j <br /> Volume: c t ( F 1A l�1 br UN(,L r►+� <br /> Chemicals: LL ev�al' Ik-t <br /> Circumstance <br /> rv.� <br /> F. ACTION T N: p <br /> SITE DISPOSITION: rut <br /> Notification of Haz D�sct <br />