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6 7 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E MAIN ST <br />STOCKTON, CA 95202-3029 <br />PHONE (209)468-3420 <br />Part I: General Information <br />Signature Name (please print) Additional Inventory Sheets Attached: <br />YesD Non <br />(Return completed form(s) to the San Joaquin County Agricultural Commissioner. Do not submit fees with inventory. Fee payment will be <br />collected based on invoicing by the Environmental Health Dept.) (rev 10/15/08) <br />KEEP GOLDENROD FOR YOUR RECORDS <br />rtify that the above hazardous material information is true and correct to the best of my knowledge. <br />....tketze <br />Date <br />RE <br />AGRICULTURAL HAZARDOUS DEC 27 O1t <br />MATERIALS INVENTORY joA juim any <br />try, Fdl+kY sawrcEs <br />SAN JOAQUIN COUNTY <br />OFFICE OF THE <br />AGRICULTURAL COMMISSIONER <br />2101 E. Earhart Ave., Suite 100 <br />STOCKTON, CA 95206 <br />PHONE (209) 953-6000 <br />Business, Farm or Ranch Name: Site Locations/Address (include zip code): <br />giiso E- , ,--TaAaiez i Ai • aka/nib <br />Phone No: <br />\-i dek-n. Pt.Ri C— Z;(1- ( R- <br />Mailing Address (if different from above): <br />S2 3 ;2 7, Z etee f 6 ed 1 igettotro <br />Description of Business/Operation (Farm, Nursery, Etc.): <br />e P....1 <br />Nearest Crossroad: <br />D115*1.1 0 4 8 le- kik e i la. <br />Emergency Contact Person: <br />_-"Re-rie Fa ei eL. <br />Phone No: <br />g r3 - 5"/ ski <br />Pesticide Permit / ID No: Fire District: <br />k`ee,e7 4-4/- <br />Part II: Hazardous Material In • • <br />Material Name <br />titL,........e. <br />r DOT # - <br />Container <br />Type <br />........ • .•••• r • .... .....•••w.... <br />Container SizeMax. <br />ir•••• a •••r •••••• <br />Number <br />of Containers <br />(at any I time) <br />r6, a ••••. tom. .7.B.J.S. U.l. Ifalli“.1 LIG., <br />Circle the Months On Site <br />l'? -5 olijogaiiii 2 aiFMAMJJASON <br />ir oy..; ,-,7 / 6/MAMJJASOAO N r .../ <br />JFMAMJJASOND _ <br />JFMAMJJASOND <br />_ <br />_ JFMAMJJASOND <br />JFMAMJJASOND /Min uvir, D <br />JFMAMJJASOND O EC 0_ 2 2041 <br />JFMAMJJASOND SAN JOAQUIN COUNTY <br />JFMAMJJASOND <br />AtatilL. COMM. LODI <br />JFMAMJJASOND <br />_ _ <br />_ JFMAMJJASOND <br />_