Laserfiche WebLink
SAN JOAQUIN COUNTY •~Ep CI)AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS A 4 OFFICE OF THE <br /> 600 E MAIN ST '�n RICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY ZQ 2101 E.Earhan Ave.,Suite 100 <br /> PHONE(209)468-3420STOCKTON,CA 95206 <br /> QU'N <br /> QF C0l1NTY PHONE(209)953-6000 <br /> Part L-General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> NW\ 1 Far I\q W LtOU CA qvl '113LS <br /> Mailing Add Cis(if different,from above): / V Description of Busin Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> '� ;Jeot'Z UGI C(T �j lc, V—a o rk o A <br /> Emergency Contact Person: Qi! GQ d PhoneNo- <br /> Q Pesticide Permit/ID No: Fin <br /> ^Distri'ctt /I, ' 1 <br /> W ,1 \„0.1. _ / ` !aj%ei e <br /> "u�� YYYJJJ tt` ���rrr vvv / <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# 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 /> 11 at an Itime <br /> Q7cL6 S� aN1i% ,\ IJFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> M2 8 2017 <br /> JFMAMJJASOND <br /> AGRIG.COMM.IADI <br /> JFMAMJJASOND <br /> JFMAMJJASOND Ri=CFIVED <br /> JFMAMJJASOND <br /> I certify hat the ab hazardous material information is true and rrect to the best of my knowledge. <br /> Min G <br /> 1 J M �\pt� �q <br /> �, 11?ln 1„iC L\A� 1 \JL.r'I V" 11Additio(WaliiiyenfuryS flat <br /> Signature Name(please print) Date Yes❑ N I <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 />