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PQ91N' SAN .JOAQUIN COUNTY (2,4 <br /> E .IRONMENTAL HEALTH DEPAR i___ENTa <br /> . �. 600 E.Main Street, Stockton, CA 95202-3029 D <br /> Te! hone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/ehd <br /> A��FORa <br /> NOTIFICATION OF HAZARDOUS WASTE DISCFR EE <br /> California Health & Safe Code Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVELOI II III <br /> (Circle One) <br /> B. SOURCE OF IN FORMATION <br /> Name: iAJ !PkK_) Phone: p-?) qb 8--1 PS <br /> Company: <br /> Address: City: Zip Code: <br /> Designated Employe Name: <br /> Reporting Agency ame: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: L b /\A 0L) , S� c.(L�� / Cit County <br /> (Best Physical Description) ircle One) <br /> Date of Discharge: kAat'j Date Notified: �j Time: A.M. P.M. <br /> D. RESPONSIBLEPERSON/BUSINESS <br /> Name of Business: U <br /> Contact Person: Phone: ( ) <br /> Physical Address: City: Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: So i L <br /> Volume: YNJKn <br /> Chemicals: v'% <br /> Circumstances: 61,E <br /> Y r w <br /> F. ACTION TAKEN 420-. Iya�'� [Q, I-� ��� <br /> SITE DISPOSITION: 5 ('Q-µAi in <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2067 <br />