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SAN fi OAQUIN COUNTY, <br /> z ay ENVIRONMENTAL HEALTH DEPARTMENT" <br /> 304 East Weber Avenue,'3rd Floor,'Stockton, CA 95202-2708 <br /> • (209)468-3420•Fax:(209)464-0138-!Web:www.co.san-joaquin.ca. I h D <br /> NOTIFICATION OF HAZARDOUS WASTE DISCRC <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVE I II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: C�rU Phone: (6d a) b <br /> Company: C 4,,z,C "f-rti 9[,Ao/K� <br /> Address: City: Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: CSI C—.--Ap 4 ra 4 A- . / CijyoCCoun) <br /> (Best Physical Description) (Cir a On <br /> Date of Discharge: 15 /6 9 Date Notified: 16 444 Time: te e�D nA MM P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Natne of Business: �/&n 4 44 VO^4o�!,— <br /> Contact Person:- �eIJ,L K <br /> Phone:�l6) � <br /> Physical Address: '�� ��' - City: ky- C r IA Zip Code: <br /> Mailing Address: ��D, D)C j City: w Skt M41V-0 Zip Code: Ct c� <br /> E. DESCRIPTION <br /> Type ofDischarge: <br /> Volume: Y, 0'0 Y' -- --- <br /> -Chemicals: ¢ P2v e C✓ <br /> Circumstances: r u Lu_ rQ 1 f +'er'b-b ,reit- try i 1 t A / 2 ;a ea4 <br /> F. ACTION TAKEN: L� [ N f i,, 1p <br /> g4CAA n 5 q n., <br /> Ar qgf-11, <br /> SITE DISPOSI ION: ,t..�_ C&A kAi✓l 4A <br /> EHD 22-02-003 F Notification of Haz Discharge <br /> 10/2/2003 <br /> i <br /> J <br />