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SAN JOAQUIN COUNTY VE® SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS OFFICE OF THE <br /> 600 E MAIN ST2010 AGRICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY APR 16 2101 E.Emhart Ave.,Suite 100 <br /> PHONE(209)468-3420 1 STOCKTON,CA 95206 <br /> /4 Nb p SAN d0AQUIN C0ij" PHONE(209)953-6000 <br /> Part I:General Information { I OMQEQFEMERGENCY <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> 0/90 Tyn ti- Z 223sSti. (yw 9f ACa/h pz QL ,20g &3,3 �s�z <br /> Mailing Address(if different from above): Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> Agaas / &(Ila % � P'-/74-ex, a <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: Fire District: <br /> o f M LV z ?�9 333-/s)z 39- U S Z woodbt,' do <br /> Part IT: 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 M Container Container Size Max.Number Circle the Months On Site Locations(s)on the property(e.g.in barn,NW <br /> Type of Containers <br /> <br /> <br /> li%�c(L 1 JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND Zulu <br /> JFMAMJJASOND u <br /> UNTY <br /> JFMAMJJASOND AGRIG.COMM. <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> rtify that the above h zardous material information is true and correct to the best of my knowledge. <br /> /LGiJ (� �f/�/P/h �n /Y/1 A �[ /Y) elVe Z 7/(� Additional Inventory Sheets Attached: <br /> Signature arae(please print) Date Y¢S❑ Nogg <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. 10/15/08) <br /> KEEP GOLDENROD FOR YOUR RECORDS <br />