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o?q c SAN JOAQUIN COUNTY <br /> Q ENVIRONMENTAL HEALTH DEPARTMENT SPK D <br /> 600 East Main Street Stockton ■CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138 ■ Web:www.sj og v.org/ehd <br /> � A <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAC <br /> A. EMERGENCY LEVEL X I I EHD LOG# _0 SG <br /> B. SOURCE OF INFORMATION yx / <br /> NAME: U/4-t,(,(.a PHONE: <br /> COMPANY: //r kw OIL6l . rada6^ CITY: <br /> ADDRESS: D <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: "6 w CI'T'Y � Incorporated <br /> Best Pays"Description U <br /> Uninco orated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: 2S� TIME: - <br /> D. RESPONSIBLE PERSONBU//SIN//ESS <br /> NAME OF BUSINESS: WQS w �D 2 �7'1 <br /> CONTACT PERSON: b 0. w � PHONE: D Z3�' /U <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: l�Tv <br /> VOLUME: /L/ <br /> CHEMICALS: A S <br /> CIRCUMSTANCES: �� /�✓G ` / <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> flvm, fm� <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />