Laserfiche WebLink
*1/6q� EIVE® <br /> SAN JOAQUIN COUNTY SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AGRICULTURAL HAZARDOUS 7 'n, OFFICE OF THE <br /> 600 E MAIN ST FE Y ZQ�Q,RICULTURAL COMMISSIONER <br /> STOCKTON,CA 95202-3029 MATERIALS INVENTORY 2101 E.Emhart Ave.,Suite 100 <br /> PHONE(209)468-3420 BAN IIIAQUIN COUNTY PHONE STOCKTON, <br /> A 95206 <br /> OFFICE OF EMERGENCY SERVICES <br /> Part I:General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include zip code): Phone No: <br /> HW I ?, Fq MA-S f e- lQ UJ, N10 1a, "U- <br /> Mailing <br /> Mailing Ad ess(if different from <br /> f above): rN Ili. Description of Business/Operation(Farm,Nursery,Etc.): Nearest Crossroad: <br /> 3�K0 PJCotO1Vel Cir I � Fat (27-u4f-A <br /> Emergency Contact Person: Phone No: Pesticide Permit/ID No: Fire District: <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 N 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 Itime <br /> Ot �.]Sz1 I �Cinbl 00 JFMAMJJASOND S E <br /> QrG-601JF MA MJ JASOND E <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> I(cceertify that the above <br /> h us material i formation is true and correct to the best of my knowledge. <br /> 1 t I c X1 v �� MI�Q�—t Ih Additional Inventory SI eets Attached: <br /> Signature Name(please print) Date Yes❑ NO <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 />