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SAN .10AQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209) 468-3420 • Fax: (209) 464-3433 • Web:www.slgov.orq/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE jEHDL0G#j I (-)& <br /> EMERGENCY LEVEL: <br /> I <br /> -No Evacuation/Local Response Only ❑ II-Evacuation and/or In-County Mutual Aid Needed ❑ III-Evacuation and/or RegionallState Mutual Aid Needed <br /> SOURCE OF INFORMATION <br /> NAME: PHONE: <br /> G- c G ICA.. <br /> COMPANY: an Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: ,,,rte c 3 PHONE: ZZ)'; --Y 3'7-'[YZ, <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> LOCATION AND DATE OF DISCHARGE <br /> LOCATION: �� "y. s S:�l t j gj Incorporated <br /> Best Physical 7 CITY <br /> Description � , V. ��k-t (J�— / ❑ Unincorporated <br /> DATE OF <br /> DISCHARGE: lf.,�-rz I?J Z L f�j <br /> DATE <br /> NOTIFIED: �'�r-e, �'� ? � TIME: <br /> RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: �' ��`r -- r �/ PHONE: <br /> PHYSICAL ADDRESS: 'tea c ",. A Uc- <br /> MAILING ADDRESS: <br /> DESCRIPTION //�� �� <br /> TYPE OF DISCHARGE: 'z 0- • —A __ <br /> - �- <br /> VOLUME: G' <br /> CHEMICALS: <br /> CIRCUMSTANCES: C_ <br /> ACTION TAKEN <br /> 1- f iV�y -3i <br /> e- J <br /> SITE DISPOSITION <br /> Revised 6/01/2015 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />