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SAN JOAQUIN COUNTY <br /> y <br /> ENVIRONMENTAL HEALTH DEPARTMENT 4 <br /> H 600 E.Main Street, Stockton, CA 95202-3029 D <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/eh k, <br /> NOTIFICATION OF HAZARDOUS WASTE DISC <br /> California Health & Safety Code,Section 25180.7 <br /> EHD LOG#: (9q-f) -10 <br /> A. EMERGENCY LEVEL:0 II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: ( S V <br /> Company: b55 <br /> Address: City: Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF ISCHARGE <br /> a0 <br /> � s <br /> Location: M t' I Ci or oun <br /> (Best Phy <br /> sical De ription) (Circle ne <br /> Date of Discharge: nN f Date Notified: A/IV (i L`{ Time: �t4`7 AM. K <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Phone: { ) <br /> Physical Address: City: Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: C �n4� - <br /> Volume: GMK <br /> Chemicals: i - `h <br /> Circumstances: - <br /> F. ACTION TAKEN: 1i <br /> 4 , <br /> SITE DISPOSITION: CLe4 Id 5dadIEQ <br /> i <br /> EHD 22-03 <br /> 11/26/2007 Notification of Haz Discharge <br />