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SAN JOAQUIN COUNTY SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E.Earhart Ave.,Suite 100 <br /> PHONE(209)468-3420 STOCKTON,CA 95206 <br /> PHONE(209)953-6000 <br /> Part 1:General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> -. ,A/� �s 7�oS E w B� ©9 Yg/�2 Y60 <br /> Waiting Address(if different from above): `` Description of Business/Operation arm,Nursery,Etc): Nearest Crossroad: <br /> 140C,AL-4a rrt 1��k <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: Fire District: <br /> cc ed Ago? 8� �O ,2 O z/�'O � elm kow L <br /> Part II: Hazardous Material Information Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below and their reportablequantities) <br /> Material Name DOT# Container Container Size Max.Number Circle the Months On Site Locations(s)on the property(e.g.in barn,NW <br /> Type of Containers corner of property) <br /> at any I time - <br /> JFMAMJJASOND <br /> <br /> <br /> <br /> <br /> <br /> JFMAMJJASOND }}7 <br /> JFMAMJIAS0ND is(C�lS V <br /> JFMAMJJASONDS 10JL <br /> JFMAMJJASOND 1H n191JNTY <br /> JFMAMJJASOND AGRIC. COMM. LODI <br /> JFMAMJJASOND <br /> mceiat the above hazardous material information is true and correct to the best of my knowledge. <br /> �Q/� 4UGC/erf /� Additional Inventory Sheets tacked: <br /> Signature 6 Name(please print) Datf IYes ElNO <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/I5/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />