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aur SAN JOAQUIN COUNTY } <br /> � 6G <br /> y <br /> *1RONMENTAL HEALTH DEP AR NTE-- <br /> 600 E. Main Street, Stockton,CA 95202-3029 <br /> { <br /> �� • Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov. g/eh <br /> NOTIFICATION OF HAZARDOUS WASTE DISAGE <br /> California Health & Safety Code,Section 25180.7 J <br /> a EHD LOG#: S� <br /> A. EMERGENCY LEVEL:LV II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name; RVAIj /'4 ,064 Phone: ELn) (nf'J�l <br /> Company: rnl <br /> Address: City: L Q Zip Cade: al S 33� <br /> Designated Employee Nam <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Pb VJ1 L-!� Xll / Ci ar Coun <br /> ty <br /> (best Physical Description (Circle One) <br /> Date of Discharge: V 7-7[D Date Notified: IS 2 ` Time:! - AM P.0 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 3 S "� 6 �` <br /> CD <br /> Contact Person: TZ N Phone: , <br /> Physical Address: Lt,-77-7 Pyyy( aN f)&b city: 0�0)0 Zip Code: Ci<31D <br /> Mailing Address:_ Qf City: L'X�re Zip Code:4 3 a D <br /> E. DESCRIPTION <br /> Type of Discharge: p�lti <br /> Volume: 0 2 S L <br /> Chemicals: <br /> Circumstances: S f A [ye - Pq y 1 PJ C IV sO nc, _ +A S,Oi L '90T <br /> F. ACTION TAKEN: k1a , <br /> SITE DISPOSITION: Cu► �txm - ,� L w t Q)c C Lo t <br /> (4a Le4 !0'�'ac N�o -4 117 e 9 <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/22007 <br />