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SAN JOAQUIN COUNTY FILE .COPY <br /> i <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> (209)468-3420•Faz:(209)464-0138 Web:w.*nvco.san joaquin.ca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 251 <br /> 80.7 <br /> EHD LOG#: 04 " 06 <br /> II � <br /> A. EMERGENCY LEVEL I (Circle One) <br /> B. SOURCE OF INFORMATION phone: ( ) <br /> Name: f��l �� <br /> Company: 1 �k 1 1. 1 1, _Zip Code: 1!1 ' 1 V <br /> Address: <br /> Z'1�1 ' 2` A Sl�a 3DB _City: 1l�lVi <br /> Designated Employee Name: <br /> Ay <br /> Reporting Agency Name:j CitZip Code: S�Z YpD _ y: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE ` S Cit r Count <br /> 2 31 CJ YAAi U Circle One) <br /> Location: <br /> (Best physical Descnptidn) <br /> Date of Discharge: IJP-^ o�'�' Date Notified: <br /> il' ( DL4 Time: I I: 3� A.11i P.N <br /> D. RESPONSIBLE PERSON/BUSINESS Ddb <br /> Name of Business: Phone: ( ) <br /> Contact Person: Cit TYa-� Zip Code: <br /> Physical Address: �3� C-�rQ'r^�t Y u{s 1bY1 Zip Coder <br /> Mailing Address: <br /> C[a _City: <br /> E. DESCRIPTION /.• <br /> Type of Discharge: U <br /> Volume: <br /> � t257 <br /> Chemicals: Y -� <br /> Circumstances: , <br /> F. ACTION TAKEN: <br /> I�P.I <br /> c�G7I' <br /> SITE DISPOSITION: <br /> Notification of Haz Disch: <br />