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Part I: General information <br />'a <br />AGRICULTURAL HAZARDOUS <br />MATERIALS INVENTORY <br />SAN JOAQUIN COUNTY <br />OFFICE OF TI IE <br />A6W('Dj..TURAL COMMISSIONER <br />'PEST OFFICE BOX 1809 <br />STOCKTON, CA 95201-1809 <br />PRONE (209) 468-3300 <br />Business, Farm or jRanch Name: <br />ct <br />Phone No: <br />SAN OAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Circle the Months On Site <br />600 E MAIN ST <br />Description of Business/Operation (Farm, Nursery, Etc.): <br />STOCKTON, CA 95202-3029 <br />;Z 2 e 41 44 S <br />PI IONE (209) 468-3420 <br />Part I: General information <br />'a <br />AGRICULTURAL HAZARDOUS <br />MATERIALS INVENTORY <br />SAN JOAQUIN COUNTY <br />OFFICE OF TI IE <br />A6W('Dj..TURAL COMMISSIONER <br />'PEST OFFICE BOX 1809 <br />STOCKTON, CA 95201-1809 <br />PRONE (209) 468-3300 <br />Business, Farm or jRanch Name: <br />Site Locations/Address (include zip code): <br />Phone No: <br />Container Size <br />Max. Number <br />of Containers <br />at any I time <br />Circle the Months On Site <br />Mailing Address (if different from above): <br />Description of Business/Operation (Farm, Nursery, Etc.): <br />Nearest Crossroad: <br />;Z 2 e 41 44 S <br />1560FJ <br />lid <br />Emergency Contact Person: <br />Phone No: <br />Pesticide Permit / ID No: <br />Fire District: <br />Part II: Hazardous Material Information (Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below and their reportable quantities) <br />Material Name <br />DOT # <br />Container <br />Type <br />Container Size <br />Max. Number <br />of Containers <br />at any I time <br />Circle the Months On Site <br />Locations(s) on the property (e.g. in barn, NW <br />corner of property) <br />t t_ <br />j - <br />t. <br />1560FJ <br />lid <br />FJ MAMJJAS0ND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASOND <br />JFMAMJJASONll <br />Ntl 1 1lVliti.- r-AI[u;ii+l <br />JFMAMJJASOND <br />❑ I certify that the above hazardous material information is true and correct to the best of my knowledge. <br />-- o' t /s Additional Inventory Sheets Attached: <br />Signature Name (please print) Date Yes ❑ Nt2' <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. 10/25/07) <br />KEEP GOI..DENROD FOR YOUR RECORDS <br />