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. {w' <br /> SAN JOAQUIN COUNTY d <br /> FQUftw <br /> = 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> w: ,� ' _•:` 600 East Main Street Stockton ■CA 95202-3029 <br /> ;r (209)468-3420■Fax:(209)464-0138 • Web:www.si o� v org/ehd i <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL IXII I in III EHD LOG# D <br /> B. SOURCE OF INFORMATION <br /> NAME: — N&L PHONE: b - Qb <br /> COMPANY: ,��'p Z lu } CITY: <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: nL �� P4AA j�j,✓,� CTTy f/f� Inco orated <br /> Best Physical nescriptioa �1 (�I/�[ <br /> Unincorporated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: TIME: <br /> D. RESPONSIBLE PERSONIBUSINESS y <br /> NAME OF BUSINESS: was <br /> }� q <br /> CONTACT PERSON: Tom er i✓ PHONE: <br /> PHYSICAL ADDRESS: �} <br /> MAILING ADDRESS: t ek4tk L Nl var . (J`fCAd <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: AZ <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />