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° SAN JOAQUIN COUNTY <br /> �,O ENVIRONMENTAL HEALTH DEPARTMENT A, <br /> to <br /> 304 East Weber Avenue,3"Floor, Stockton, CA M02-2708 <br /> P <br /> AY 09)468-3420■Fax:(209)464-0138 Web:wwwco.sanjoaquinxa.us/ehd <br /> F1 C 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 'S <br /> i' <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: O -00 1 <br /> A. EMERGENCY LEVEL: I Il III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 00U a C CA(0U Phone: (2051)3 Za- 3-7/ <br /> Company: V05ver— py"e'r- Sinn Dan y <br /> Address: wAA 11'1()G-6 Si City: 5��� Zip Code: SZ6 3 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE �1 <br /> Location: �cJ Z� W Q SW I Jim S+ (City)Dr Count <br /> (Best Physical escription) (Circle One) <br /> Date of Discharge: 1- 7-- Z-0r Date Notified: "Z-' a�? Time: / , Oy A.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Phone: (Zn 3-2-0 ' 37/4 <br /> Physical Address: 252-1p W , WaSH r�4 City: StD Zip Code: C1 57?-6 <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: :Fa( <br /> `e-J woo-y-e, U#,\J n <br /> Volume: 2 00 O Qa j( Dh S <br /> Chemicals: S u r`rzZ -u A <br /> Circumstances: i2d% -e Wo ov P,A(b krid awls ,5 e <br /> 2 000 o 11(6A S !!�.(�' I`i ZL A-6 a n e cart LjQ <br /> )n vne4,\:,}- <br /> F. ACTION TAKEN: T'-�.lm.DOJ'd M mak- Sj Si'r� FIS b e u�5 c.l <br /> Ccs n* 'i Y\ q-y1,4-eAA=1-s O'k wi.c- S u r l 0 6 t h ki <br /> S e LOLS O rw► i-S bu,vn peal QUA- 616J J13P <br /> of erb pe-�[yF <br /> SITE DISPOSITION: <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />