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q SAN JOAQUIN COUNTY Q <br /> ENVIRONMENTAL HEALTH DEPARTMErfT D <br /> to.. X 600 East Main Street Stockton R CA 95202-3029 <br /> (209)468-3420■Fax:(209)464-0138 ■ Web:www.sisov.or; le ehd <br /> NOT F CATION O HAZARDOUS ST S HARG <br /> A. EMERGENCY LEVEL I X EHD LO G# ll--O5 <br /> B. SOURCE OF INFORMATION <br /> NAME: SC/V� PHONE: pa sgpo <br /> COMPANY: ] kVCITY: <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PHO E: Z[9 4-lot-73+a <br /> REPORTING AGENCY NAME: 7 <br /> ADDRESS: C7 C, s C.{c- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: ry Inco ted <br /> B-enr nascrpa� �� LO(,i.t�R <br /> Umnco rated <br /> DATE OF DISCHARGE: Z ` <br /> DATE NOTIFIED: TIME: 1 _ —}- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: (gyp hi <br /> CONTACT PERSON: �� PHONE: �- <br /> PHYSICAL ADDRESS: <br /> MAE-ING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: ,_ <br /> VOLUME: <br /> CHEMICALS: <br /> CIRCUMSTANCES: k,D l� <br /> F. ACTION TAKEN f <br /> SITE DISPOSITION <br /> wc.e fit sXV-d toc ,6 <br /> s <br /> I# dZU4 w f <br /> ER RECORD MODIFIED Revised 05101/2007 <br />