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'o-qur?v a SAN JOAQUIN COUNTY -" ) F <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> v 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209)468-3420• Fax:(209)464-3433• Web:www.sioov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x I ❑ II ❑ III EHD LOG# - 11 ;t, <br /> B. SOURCE OF INFORMATION <br /> NAME: I Garrett Backus PHONE: (209)468-2986 <br /> COMPANY: I San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: Garrett Backus PHONE: (209)468-2986 <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: t-i"+- _/ Inco orated <br /> Best Physical 11C-- <br /> n <br /> CITY <br /> L-`�7 1-1 Unincorporated <br /> Description P-x ;� cc <br /> DATE OF DISCHARGE: 0'+ '2, ) <br /> DATE NOTIFIED: TIME: 'm <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: G4- �r'17 <br /> CONTACT PERSON: CI .�' 14 ct{� `{- <br /> PHYSICAL ADDRESS: ( s ,;.Q <br /> MAILING ADDRESS: Lt�kl�btr C"lI Fs „� C" °lam /J'I -'LG <br /> E. DESCRIPTION If/ Fi105:& <br /> TYPE OF DISCHARGE: `j` p�I �i'YiN,— t..r� irc d T e; - <br /> VOLUME: <br /> CHEMICALS: <br /> CIRCUMSTANCES: OAtii:Q.r'2t T151)0191— <br /> vy cel i �R7. r ", ^� t'n '-e" <br /> F. ACTION TAKEN J n (- d(� Z (� <br /> `Ga1j,por54'610- P�rT !�v`ciG.�+1��C GlOs'w..� r7CVe,Lic t ,Q <br /> yyh� r Glow �P 7ol�iG ��cQQz , <br /> SITE DDISPOSITION <br /> 0 <br /> Revised 08/02/12 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />