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D6� <br /> FIND <br /> o " c SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> k z 600 East Maul Street Stockton • CA 95202-3029 <br /> (209)468-3420■Fax.(209)464-0138 • Web.www.sigov.org/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL I X EHD LOG# d <br /> B. SOURCE OF INFORMATION <br /> NAME: : �-,j ��,ko,r f PHONE: Ca(j r b-] <br /> COMPANY: j ! CITY: <br /> ADDRESS: W 4G.- <br /> DESIGNATED EMPLOYEE NAME: . PHONE: <br /> REPORTING AGENCY NAME: ^ <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: 7�7 4p,0 CITY Inco rated <br /> Best Physia Descrioi00 <br /> Unincorporated <br /> DATE OF DISCHARGE: OVOat <br /> DATE NOTIFIED: TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: <br /> CONTACT PERSON: ' PHONE: 6b D^J <br /> PHYSICAL ADDRESS: e>Q ��' .�� -5,L <br /> MAILING ADDRESS: c-A I <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> S��11 ti•u Wil[ t7� �"-�� � �cs�� 'C�r I'�il�[ o�a�i ti..e. , <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />