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dook <br /> SAN JOAQUIN COUNTY <br /> r E IRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3'd Floor, Stockton, CA 95202-2708 <br /> `Q (209)468-3420-Fax.(209)464-0138 Web:viww.co.san-joaquin.ca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: -00 1 <br /> A. EMERGENCY LEVEL: I II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 10 Loa C CA b; L Phone: (205) 3 Z.a a 37 <br /> Company: V05 Er- PD"E r (zPn Oa A V <br /> Address: �� W., ( +h , Sf City: gf-o Zip Code: SZ(�3 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �L-5 Z(O W Q SIS 1 1 ST / arCounty <br /> (Best Physical escription) (Circle One) <br /> Date of Discharge: I- 2- ZC)� Date Notified: "2-`' ��4 Time: ' ay A.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -P®s'D 5F Powe-4- 61D A, cm� <br /> Contact Person: leo C ao t Phone: (Z Zq) 3.2-0_ 37/ <br /> Physical Address: Z521,; W , WaSH(r) ity: stp Gy ''\ Zip Code: 5?-63 <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: Fd, �o-J A- V-e,(a a U lb n k-- <br /> Volume: 2 D O 0 qQ t( O YI S <br /> Chemicals: S U. r rz u A <br /> Circumstances: Fdj -ea Farb coy!e a ctrl —jau,,IL S evv\ <br /> C> 2-000 00,116VIS In`6 SQc6rlddf� <br /> )n vne v% a neoL- <br /> F. ACTION TAKEN: T- n oeb-e <br /> Ccs n*a i n ' c3v4enn t�s G w - S u r r`z- c2 c: d i <br /> S-C 6,0r4a" CEAA-CL`l N m 'ew is .4-c> be iat,tm 8 Cl 13pa-WA <br /> Iry ke� t <br /> SITE DISPOSITION: <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />