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U �o SAN JOAQUIN COUNTY <br /> z a2 EWRONMENTAL HEALTH DEPARTSNT <br /> n <br /> 304 East Weber Avenue,3d Floor, Stockton,CA 95202-2708 <br /> (209)468-3420■Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd D'l 30 D7 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> it- <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: 07-093 <br /> A. EMERGENCY LEVELO H III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Q Phone: <br /> Company: fQ 5 �d <br /> Address: 'LS City:�To Zip Code: U'2_ <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ti L / Cit or Count <br /> (Best Physic Description) (Circle One) <br /> Date of Discharge: Date Notified: o Time: 0 0 A.M. P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: V05D0-f� Vh W tAyl <br /> Contact Person: Phone: <br /> Physical Address: 'IDYL p V, WaS�►n City: Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: H <br /> Chemicals: t <br /> Circumstances: 1 ✓cuNFOtt <br /> VQ,�nt6 o cn yv� <br /> F. ACTION TAKEN: <br /> S� OVVr 0dVtK'- <br /> g4t, dts-- -9- , I I <br /> SITE DISPOSITION: <br /> efjMe�jfAj - I I tAAp,.i/(.,/AJc <br /> S <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />