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�o 00 SAN JOAQUIN COUNTY <br /> a Gy <br /> H ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 e�az�oto a9t' <br /> P (209)468-3420•Fax:(209)464-0138 • Web:wkw.co.san-joaquin.ca.us/ehd <br /> R� FORa <br /> IFICATION OF HAZARDOUS WASTE DISCHARGE <br /> PIT <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: Ofi, —u+'1 <br /> A. EMERGENCY LEVEL-rI If III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (..#,) <br /> Company: <br /> Address: zsrxto NARY I>R- City: Zip Code: grz,, <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Osco Npv`eyE - %wLg 1-&o-f PLA-�-t %d P-cm L"I" G°"" ILCAL44 Cit or County <br /> (Best Physical Description) (Circle One) <br /> Date of Discharge: oa -Z9-oma Date Notified: O:�-2e- Time: .3;zz >m. P.M. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: <br /> Contact Person: W tt-,TE Phone: (.g* cqa <br /> Physical Address: '-s Aoaor- City: Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: 4UF%-e3►sE <br /> Volume: 90 <br /> Chemicals: 1�;SO4 <br /> Circumstances: Filo pn ori <br /> F. ACTION TAKEN r,A•� �o� �-�-�5 a»n� � o�T t t-n o -mss F«L <br /> STvRPCo rc. so <br /> SITE DISPOSITION: <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />