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SAN JOAQUIN COUNTY l D <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c (209)468-3420- Fax: (209) 464-3433 - Web:www.si.gov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ❑x 1 ❑ II ❑ III EHD LOG# � <br /> B. SOURCE OF INFORMATION <br /> NAME: cjc-4'S PHONE: '2,9 J C2 <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: PHONE; <br /> REPORTING AGENCY NAME: San Joaquin County Environmental Health Department <br /> ADDRESS: 1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: -7Z� Incor orated <br /> Y <br /> Best Physical CIT <br /> Description <br /> ❑ Unincorporated <br /> DATE OF DISCHARGE: .3 <br /> DATE NOTIFIED: 3—?jam S TIME: 3 O pz <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: ! 7t,) 5 F / <br /> CONTACT PERSON: G, <br /> . I E?C,r...+ PHONE: ��9� TL�[// <br /> o b <br /> PHYSICAL ADDRESS: 7Z.> Q c� f. S .Jc��� - ✓�✓�^c;S <br /> MAILING ADDRESS: -�-� �t 11 Cil C'2-c, <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN l 1 <br /> �y�q^Si ��� Y �r�s/= Ct7✓� �•:c��2,X /��v1 r�r�rv.eA1 l cC I L—C?cJrSf/c 5 <br /> +O C_01 e_ 5:01' exCC'U��fa _ Oh' �i�pi 11 r� Y-C� 1)e')"7Uf?� <br /> v 3 0� 0- 40 +A—IL- C,r <br /> SITE DISPOSITION <br /> c� <br /> Revised 08/02/12 Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />