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Sale JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Rs <br /> 600 East Main Street Stockton■CA 95202-3029 <br /> •:�y,;,, - __ . 09a46s.3420--Bax--4-209�.�s�o��s��a; <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL I E-O LOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: �0,"1" 1" 1�5�-1.. PHONE: 323� 7�T7'Z(�� <br /> COMPANY: CITY: <br /> ADDRESS: g ciO z�ccs it <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> O �( Inco rated <br /> LOCA'T'ION: l q g p Qi �'� CITY ����` <br /> Best Physical D--Otkm Unincorporated <br /> DATE OF DISCHARGE: �f <br /> DATE NOTIFIED: r g - 1 TIME: 3 3r7 D. RESPONSIBLE PERSONBUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: PHONE: 12-01- <br /> PHYSICAL <br /> .ca -PHYSICAL ADDRESS: <br /> MAILING ADDRESS: <br /> E.. DESCRIPTION <br /> TYPE OF DISCHARGE: L p <br />' VOLUME: OO ca S <br /> CHEMICALS: <br /> CIRCUMSTANCES: a ,. <br /> F. ACTION TAKEN rr <br /> Ci�=in,�� C.7+`�1""g f`C'S po� —'� C.E@a.,p,..,'�" 5'�W►—�X�'w i--•o <br /> SITE DISPOSITION <br /> ER RECORD MODIFIED Revised 0510112007 <br />