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SAN JOAQUIN COUNTY <br />ENVI�)NMENTAL HEALTH DEPARTME <br />-600 E. Main Street, Stockton, CA 95202 <br />4 (209) 468-3420 • Fax; (209) 464-8392 • Web www.co.san-joaqum'.ca.us/ehd <br />G/PORN _ ,. ,. . <br />O OTIFICATION OF HAZARDOUS -WASTE DISCHARGE <br />Californ*644alt S e; Section 25180.7 <br />- o . r* EHD LOG #: n 7'�02/� <br />A. INEMERGENCY LEVEL II III <br />(Circle One) <br />B. SOURCE OF INFORMATION ... <br />Name: <br />Company: EE T <br />Address: a2 8 3 <br />Designated Employee, Name: <br />Reporting Agency Name: <br />Address: <br />flJ� <br />P.E a <br />:: A . <br />Phone: (92.4 Got - j1 0 -qJ <br />TIG <br />Zip Code: 54S-23 <br />Zip Code: <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: S y rt WaytRs' "C /(67t -Ar Count <br />i (Best Physical Description) f --rCircle One) <br />Date of Discharge: 2 tl n fiz? jf�v n y Date Notified 'G�L2 Time: a %. is A.M. r.M. <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: �isr}d/�r ;nS QA%flnn Co o'Pr 77nL, <br />Contact Person: o } P,1 e I Phone: (201P .547 - 2 2 x 2 - <br />Physical <br />Physical Address: 2& S J S. ;roe a City: r lz.� Zip Code: 2 U <br />Mailing Address: <br />it S Zip Code: 'YC2/) <br />E. DESCRIPTION <br />Type of Discharge: 7','=oov� <br />Volume: <br />Chemicals: IJ res a <br />Circumstances: Ms' Mot u.-.9 .17 i' ua h r' -� L- 6+ Enc, n f i -f"c j <br />F. ACTION TAKEN: <br />LY, <br />SITE DISPOSITION: <br />EHD 22-02-003 <br />05/04/07 <br />11 <br />0 <br />Notification of Haz Discharge j <br />