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.• • SAN JOAQUIN COUNTY <br /> K ENMoNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3 'Floor, Stockton, CA 95202-2708 <br /> p' (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG <br /> A. EMERGENCY LEVEL: 11 III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: eml &rm" Phone: (to)_*g!57-�1 (21 <br /> Company: ✓ <br /> Address: City: c Zip Code: �SLb(P <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City. Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: JAI-1 yVyl <: o-f rlflVtl / rii r County <br /> (Best hystc�cnption) (Circle One) <br /> Date of Discharge: Date Notified: ' 0 1 Time: 10 •Q 1 a P'M' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ndct/ W4ya 1/) <br /> Contact Person: rdA Phone: ( ) Its 1�tly <br /> Physical Address: iq 0V�1 �/, City• Zip Code: a 5'10V <br /> Mailing Address: U Vi City: 1 I 1 t• Zip Code: " <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: J1 a <br /> Chemicals: <br /> Circumstances: my uwa 0 aQ11V'11 <br /> F. ACTION TAKEN: Ty -W ytVeF �Aq 12 iC <br /> SITE DISPOSITION: av v <br /> AVIA is , <br /> LA <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 10/2/2003 <br />