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�o co SAN JOAQUIN COUNTY <br />- G <br />El .. �RONMENTAL HEALTH DEPART NT <br />1"i • ra Stockton, CA 95202-2708 �` D <br />�4 (209) 468-3420 • Fax: (209) 464-0138 • Web: www.co.san joaquin.ca.us/eh <br />� AORa � OGS <br />qOTIFI ATION OF HAZARDOUS WASTE DISCHARGE <br />CD California Health & Safety Code, Section 25180.7 <br />C-2 <br />EHD LOG #: c:5� 7 -/SC3 <br />A. EMERGENCY <br />B. SOURCE OF INl <br />Name: -5-; <br />Company: N 1 o"N <br />Address: <br />Designated Employ( <br />Reporting Agency IS <br />Address: <br />C. LOCATION <br />Location: Q <br />Date of Discharge: <br />D. RESPONSIBLE <br />Name of Business: <br />Contact Person: <br />Physical Address: <br />Mailing Address: <br />E. DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals: <br />Circumstances: <br />JEL6) II III <br />(Circle One) <br />RMATION <br />4),Lr i C 1241' 1(`U0 <br />Name: <br />ne: <br />City: <br />City: <br />g 8$ <br />Phone: g1g) 9-77 - 72� <br />Zip Code: <br />Zip Code: <br />DATE OF DISCHARGE <br />Ci r Count <br />(Best Physical Description) Circle One) <br />2 S Date Notified: 1l Z Time: A.M. <br />SON/BUSINESS <br />5 b1.) �--a,G7-(f L 1241 l rb-A <br />:i9 g l A+V,1^Sro-j s4-. <br />F. ACTION TAKEN: <br />r-Dvl-�. - <br />k3 <br />. ) .. --t- . ..le <br />Phone: (UI � S14 I ADZ <br />City: Zip Code: <br />City: 1z 6 r&y Y 11", Zip Code: al 7 <br />L,61 <br />SITE DISPOSITI'�IOL U <br />EHD 22-02-003 Notification of Haz Discharge <br />10/2/2003 <br />