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66 <br /> 0?4 �."` SAN JOAQUIN COUNTY Q <br /> o <br /> ENVIRONMENTAL HEALTH DEPARTMENT D <br /> 600 East Main Street Stockton*CA 95202-3029 <br /> ' :. (209)468-3424•Fax. (209)464-013$• Web:www.sigov <br /> or ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISC E,., <br /> A. ,EMERGENCY LEVEL X JEMLOG# I <br /> I B. SOURCE OF INFORMATION <br /> + <br /> NAME: r�o-C+fi a L. PHONE: ZoQ-'?9Z lei ZO r 13 <br /> COMPANY: ��.�.- + �o'��!"+r4l�i`�...� CITY: <br /> ADDRESS: oZ� ,yZ.c��.5t•{w I v <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: 10 Z rCITY Inco rated <br /> Bm Phymcal Dmrgn=k�► <br /> }' Unincorporated <br /> DATE OF DISCHARGE: <br /> DATE NOTIFIED: TIME: -o <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: - ,�,,,,- .,� <br /> CONTACT PERSON: o er 440_X4,41. 1 PHONE: <br /> PHYSICAL ADDRESS: rA <br /> MAILING ADDRESS: PC JROX 6t2-19 <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: 1 <br /> VOLUME: <br /> CHEMICALS: /a... �lvf:oPe ot~e,4 G.4r_ g a ig d ff l",'ix 42 1-ta aA <br /> CIRCUMSTANCES: diM Gnt I`P�5 orgy <br /> F. A.CnON TAKEN 0 <br /> 44T 1 /� / <br /> GIS` y p@v,e..w.s. Y"i►�S�K Gicllljjfitl R^4-o -Hw- i�^IXc y"{Ylq <br /> �vrh51ty ca- -fy wee r1 G..�Y+./! t✓��L �r'w..e� <br /> Qtr t,J cp�I'Se."+^9a 4o -•{ Gly 5¢.�.-�c r, v' rsr'�L . <br /> SITE DISPOSITION <br /> G(ea 9NL^f ea'-f(c fr , <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />