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�✓ Ohl <br /> a <br /> Pq 1N SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> " 600 East Main Street Stockton•CA 95202-3029 <br /> (209)468-3420•Fax:(209)464-0138• Web:www.sj og v.orgjehd (( 7 I� <br /> 4CIFORN -.._i rl V <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE J <br /> A. EMERGENCY LEVEL IXII I I 'llIII EHD LOG# - 0 <br /> B. SOURCE OF INFORMATION <br /> NAME: SCa neSe.r� 4v.•i�' PHONE: Zo9-%5 Yi—2S/( Y-6 3n <br /> COMPANY: CITY: `4 Thr 957, <br /> ADDRESS: W Ian vee <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: �--- <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> - -LOCATION: +t.,- o 'F /fn'o- CITY / L X � Inco o rated <br /> &A Phym..]°Sol /6-7-7-7/6r,-7lJt7w(rWK K �-1�•'r�! <br /> / � Unincorporated <br /> DATE OF DISCHARGE: ^y_ G <br /> DATE NOTIFIED: i _ Z_ o TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: Gj w <br /> CONTACT PERSON: PHONE: 2o9- 64 - <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: ,i/e� (e.��Q /�ILt /� G <br /> E. DESCRIPTION <br /> TYPE OF'DISCHARGE: q G -ll•b„— G�ty,-., ,' �- <br /> VOLUME: <br /> CHEMICALS: tqq QN"-�er�i q <br /> CIRCUMSTANCES: ' ) <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> �jPi'l� b[{o Soi / t � s IAF `oKv�tx fk� . 0.)04.0� H-w/{L <br /> l..iir'� hcTe+-' Ga5¢� •�.� l.-�+`fcr Qoe+-•+p �Hr,Q DTSc' . <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />