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77 <br /> SAN JOAQUIN COUNTY a <br /> ENVIRONMENTAL HEALTH DEPARTMENT D <br /> Q <br /> z• o <br /> 604 East Main Street Stockton•CA 95202-3029 <br /> rr.4. (209)468-3420•F=(209)464-0138Web:www, ov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR61E," <br /> A. EMERGENCY LEVEL I x I EHD LOG# <br /> W-09 <br /> B. SOURCE OF INFORMATION <br /> NAME: PRONE- <br /> COMPANY: jp_ f- CITY: <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PRONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: •'•� <br /> C. LOCATION AND DATE OF DISCHARGE �p� <br /> LOC On C �w lQ� t qy CITY lj Inco rated <br /> Bea phyzkw <br /> unincorpol2ted <br /> DATE OF DISCHARGE: ` SO <br /> DATE NOTIFIED: TIIAE. <br /> D. RESPONSIBLE PERSON/BUS114M <br /> NAME OF BUSINESS: �. 4 <br /> CONTACT PERSON: PHONE 3 <br /> 7tFPHYSICAL ADDRESS: -7 2 <br /> MAMjNG ADDRESS: fb �U <br /> E. DESCRIP'T'ION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: AiliryMtAd ' <br /> Lt <br /> CIRCUMSTANCES: f <br /> F. AMON TAKEN <br /> � m 0,m t6 `ng r1e�� �y tt�, �cc f e• pu►Oe, d M <br /> w1�1 �drkt t3 2,0D ca 4f Q, isaired j awe micas I I <br /> SITE DISPOSITION <br /> C,z-o (;Ii be, UCa VVV ej Ixpt- i Ah fvL ci G+j s �(D rsess Af <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />