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"gt,tn, SAN JOAQUIN COUNTY v lulr' <br /> _ c , <br /> ti� EN E -IRONMENTAL HEALTH DEPAR i_ N <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> v <br /> A P • Telephone:(209)468-3420 Fax:(209)468-3433 Weh:www.sjgov.or; d j <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHA 4. <br /> California Health & Safety Code, Section 25180.7 e <br /> EHD LOG <br /> A. EMERGENCY LEVEL II I11 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (A1 977—7 2(cI <br /> Company: 10 A,-b i J1 f <br /> Address: 4'1L-1 516 � f S S'� City: v Zip Code: 7�f <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: o P- 4�n /20 r Ut-C,1-A C a'/A"P / Ci r Count <br /> (Best Physical Descripti n) () (C' e One) <br /> Date of Discharge: c� b Date Notified: � �G/d �5 Time:-( A.M. P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS n,� <br /> Name of Business: U/i l ort A 44.' L <br /> Contact Person: /Aj11e, Gr AA �-- Phone: 7`/33 <br /> Physical Address: City: Zip Code: <br /> Mailing Address: 1 tj 6 JA �^ P0•City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: 22 c <br /> Volume: Aga V. f!SjjC/-' <br /> Chemicals: cn.kU L► <br /> Circumstances- n UN l- <br /> F. ACTION TAKEN: O .O S4o-it"�Lk �g(k n af1 (tel J-f� t� 61117''Ij <br /> SITE DISPOSITION: t''i <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2007 <br />