Laserfiche WebLink
o Dopo. "!••F SAN JOAQUIN COUNTY 1Z Z 11 <br /> a.ir,.El-•.o <br /> er ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton •CA 95202-3029 <br /> (209)468-3420•Fdx:(209)464-0138• Web:www.sjeov.or¢/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE.DISCHARGE, <br /> A. EMERGENCY LEVEL EHD LOG# —) Z <br /> B. SOURCE OF INFORMATION <br /> NAME: PHONE: 6 zj <br /> COMPANY: ,�,, CITY: <br /> (00 S? �7v✓� <br /> ADDRESS: V . MAi p <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: CITY Inco ated <br /> &a fTyaY .\JAVPn✓� <br /> J <br /> u <br /> worporated., - <br /> DATE OF DISCHARGE: I 3a I I <br /> DATE NOTIFIED: )) 3p 1 TIME: <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> NAME OF BUSINESS: ke1 G 4 <br /> CONTACT PERSON: �+ PHONE: d,5 <br /> PHYSICAL ADDRESS: NQ•V - 1En a <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: 1, tit/W!' f <br /> CHEMICALS: ,A <br /> CIRCUMSTANCES: O✓YA. <br /> F. ACTION TAKEN �. <br /> A-STS <br /> V,yV&. I (AM0 f kO144 "0 5U-Mf.. -ti bL LA&A- <br /> P AA40P f� <br /> SITE DISPOSITION <br /> ER RECORD MODIFIED Rcviwd 05/012007 <br />