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0 4u IV SAN JOAQUIN COUNTY F Q <br /> f 'IRONMENTAL HEALTH DEPART 'NT 1 <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> 17 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/eh ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISC: <br /> California Health & Safety Code,Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: (-7U i I I2 r1") D 2 eyeg Phone: QDjj) 4 b C 0D7q <br /> Company: S VGIL 'o►J ��PGS <br /> Address: X17IJ C L bQf'A A A SL .City. �• aG 11.j Zip Code: c'! 0 Z <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> 2S P�l� l)N�i�� -{- S_ a6aORJ E , / �� / Ci rCoun <br /> (Best Physical Description) ircle One) <br /> Date of Discharge: L�' 3 Date Notified: S 3 Time: C� <br /> A.M. <br /> M. <br /> D. RESPONSIBLE PgRSONBUSINESS <br /> Name of Business: P• 6- -F 5 <br /> Contact Person: P Vdf- Phone: T7- gcl 02- <br /> Physical Address: City: Zip Code: <br /> Mailing Address: QA 0 t)rpkjS [brme Db City: �nSaj j CAM YJ Zip Code: 9 <br /> E. DESCRIPTION <br /> Type of Discharge: '74)'i <br /> Volume: 0,30 54 G <br /> Chemicals: h at Z.. L <br /> Circumstances: GG>,,-,jjQ4AeA <br /> F. ACTION TAKEN: CON �(`gVi eL_ <br /> SITE DISPOSITION: r iA 0( i 61 A M.4 yi i U , <br /> C ter) <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2007 <br />