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SAN JOAQUIN COUNTY . ' <br /> ` FILE COPY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3 d Floor, Stockton, CA 95202-2708 <br /> 6 �P <br /> (209)468-3420•Fax:(209)464-0138 • Web:www.co.san-joaquin.ca.uslehd <br /> �� FORa <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#:A. EMERGENCY LEVEL H III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 6 44.0 Phone: (2o?) N6 S— 7369 <br /> Company: K 1 nd Qf- M Or 0F�J <br /> Address: 2'I" 7 W AN�j 11r• City: 9 6&4G Zip Code: Sq 206 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 201"'7 N ,4N� b r 94 <br /> 6 V�koli / City r County <br /> (Best Physical Description)tion) // Circle One) <br /> Date of Discharge: I 112 710-b Date Notified: Time: 11, 2 7 A m�) P.m. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: 141AJ e r MOL-3-"J <br /> Contact Person: Fl- OTSO Phone: (211 g6S- 726q <br /> Physical Address: 2'1(-1-1 N#v D/`• City: i;k6 ehO4 Zip Code:qcTZ06 <br /> Mailing Address: I 1 CFO Tow^ -t 6wht t 4 !City: D/-ani_Zip Code: '1 z 8�o <br /> E. DESCRIPTION <br /> Type of Discharge: VO4 — <br /> Volume: 0 tj V-A V w'J <br /> Chemicals: (o 4S o 1 W-C. , b 1 eL - <br /> Circumstances: (2) 1 " Vt1w1 wen- W�1° )"1 t i1nl - <br /> (Z) b " K 6" 94iN4 F. ACTION TAKEN: vw zr e. f up <br /> SITE DISPOSITION: f 1 w t ul MP-v 4v C V RN Q CA <br /> Ulan <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />