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UL <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenge, Stockton, CA 95245-6232 <br /> (209)468-3420- Fax:(209)464-3433- Web:www.siaov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL ® 1 ❑ II ❑ III 1 EHD LOG# Dlb <br /> B. SOURCE OF INFORMATION �r <br /> NAME: rrl PHONE: <br /> COMPANY: San Joaquin County Environmental Health Department CITY: Stockton <br /> ADDRESS: 1868 E. Hazelton Ave. <br /> DESIGNATED EMPLOYEE NAME: 5 PHONE: ` 6t—25 YG <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: pit / Au[ �� ��C�+�-� In rated <br /> Best Physical CITY S1e� <br /> Desai don Unincorporated <br /> DATE OF DISCHARGE: . <br /> DATE NOTIFIED: TIME: Lf i(x7 r <br /> D. RESPONSIBLE P RSONIBUSINESS <br /> NAME OF BUSINESS: '76ar <br /> CONTACT PERSON: for tl4r PHONE: T 2,o;— t a <br /> PHYSICAL ADDRESS: h <br /> MAILING ADDRESS: <br /> E. DESCRIPTION M55-e; <br /> TYPE OF DISCHARGE: <br /> VOLUME: io IPO P4pL^'4 <br /> CHEMICALS: <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN l + <br /> jre�k 4o <br /> l� <br /> SITE DISPOSITION <br /> yf�� <br /> v <br /> Revised 08/02112 J Page 1 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />