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" SAN JOAQUIN COUNTY L D <br /> z D <br /> H � ENVIRONMENTAL HEALTH DEPARTMENT �� <br /> 600 E.Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sjgov.org/eh <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25150.7 <br /> EHD LOG#: -O <br /> A. EMERGENCY LEVEL Tl II III <br /> v� I <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: <br /> t <br /> Address: 3 3 City: 4o, Zip Code: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: vi 4 Ci r Cogpty <br /> (Best Ph sical Descrip' n) (Circle One) <br /> Date of Discharge: Date Notified: ime:-_ A-N._ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business:' <br /> -6 6ywl <br /> Contact Person: Phone:q t6) SL 3 59 <br /> Physical Address: o jul9 6 City: Zip Code:q,Ca q-t) <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: D a a�m <br /> Chemicals: <br /> Circumstances: Gam j <br /> F. ACTION TAKEN: oZ, '(A&d l i Kky to :6 C akk <br /> SITE DISPOSITION: cv► <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2007 <br />