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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />(209) 468-3420 • Fax: (209) 464-3433 • Web: www.siciov.orq/ehd <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />EMERGENCY LEVEL: <br />I=]I - No Evacuation/Local Response Only 0 II - Evacuation and/or In-County Mutual Aid Needed 0 III - Evacuation and/or Regional/State Mutual Aid Needed <br />SOURCE OF INFORMATION <br />NAME: Michelle Henry PHONE: (209) 468-3454 <br />COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br />ADDRESS: 1868 E. Hazelton Ave. <br />DESIGNATED EMPLOYEE NAME: Michelle Henry PHONE: (209) 468-3454 <br />REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br />ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />LOCATION AND DATE OF DISCHARGE <br />LOCATION: <br />Best Physical <br />Description I M Po-r , . -rlA g CITYe( C L4othivla Incorporated <br />X Unincorporated <br />DATE OF <br />DISCHARGE: 0174 1 In <br />DATE <br />NOTIFIED: (c ( <br />DATE I ri TIME: <br />RESPONSIBLE PERSON/BUSINESS <br />NAME OF BUSINESS: IlifS <br />CONTACT PERSON: 124/ 4,,, p.ernua-t- PHONE: % 324 741 2- <br />PHYSICAL ADDRESS: 14,114op 1,53.3o / !eV s 1-17,14,p, At <br />MAILING ADDRESS: <br /> <br />DESCRIPTION <br />TYPE OF DISCHARGE: te64g <br />VOLUME: illtailW" <br />CHEMICALS:"-' /1111-511:1 be Soo, <br />CIRCUMSTANCES: I (NZ 161/41 Ina iefr elf # f II 6° if 2,2'M <br />ACTION TAKEN <br />ups perseryvvit /4/11\-(44 of-604-Nei totfoce,fe-G <br />a,reol ander- fate Mot-g. "u9- sropAoti. <br />EHD LOG# <br /> ) <br />SITE DISPOSITION <br />Tgi n`di 18)-tme."-YeliI7 /1114,te <br />t tier I fai24(se <br />NOTIFICATION OF HAZ WASTE DISCHARGE Revised 6/01/2015 Page 1 of 2