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SAN JOAQUIN COUNTY � � ID <br /> � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a _ (209) 468-3420 • Fax: (209) 464-3433 , Web: www.s' ov.or /ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE JEHDLOG#1 <br /> EMERGENCY LEVEL: <br /> I-No Evacuation/Local Response Only ❑ 11-Evacuation and/or In-County Mutual Aid Needed ❑ III-Evacuation and/or Regional/State Mutuai Aid Needed <br /> SOURCE OF INFORMATION <br /> NAME: PHONE: -2 (, -Z9 g <br /> �-e. ��fes. <br /> COMPANY. San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS. 1868 E. Hazelton Ave. _ <br /> DESIGNATED EMPLOYEE NAME T� r� Ic,c PHONE: <br /> REPORTING AGENCY NAME San Joaquin County Environmental Health Depaftment <br /> ADDRESS 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> LOCATION AND DATE OF DISCHARGE <br /> LOCATION: `jJ/ �[7vr !S "'Q ® Incorporated <br /> Best Physical CITY , <br /> Description Unincorporated <br /> DATE OF +� - <br /> -DISCHARGE: �� <br /> DATE <br /> NOTIFIED: L,-� l `LS� JTIME: /2 3v L^ <br /> RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: �� t,- ; j-��- 1. <br /> CONTACT PERSON: Ce n� PHONE: ZC7`t — q6 3 4 d <br /> PHYSICAL ADDRESS: as L p <br /> MAILING ADDRESS: <br /> DESCRIPTION ) <br /> TYPE OF DISCHARGE: e , i V a..+c O r[ v— o­4,2 e <br /> VOLUME: 1j _ <br /> CHEMICALS: w- S.-. I S �/ I n ►• <br /> CIRCUMSTANCES: 12e 15a <br /> ACTION TAKEN <br /> SITE DISPOSITION <br /> (15(03. <br /> Revised 6/01/2015 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />