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ENO SAN JOAQUIN COUNTY <br /> K 304 East Weber Avenue 3 HEALTH oor, Stockton,CA 95202-27085 FILE COPY <br /> . <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co-san-joaquinxa,us/ehd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: ()(a ' 5 <br /> A. EMERGENCY LE VEL(D lI lII <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: tic N Nolanl <br /> Company: -F Phone: (2p q) 6p�p3g <br /> Address: _l p NA w ftt Lw <br /> Designated Employee Name: Citys POL V,ki�./ Zip Code: q <br /> Reporting Agency Name: <br /> Address: <br /> City: Zip Code:_ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: V\) , Ck4OL4' r V1rFF 9�v& <br /> (Best physicalDescripfion) cilyorcountir <br /> ircle One) <br /> Date of Discharge: � "J b <br /> Date Notified: q -7 6 Time: 14;10 A.M.lPM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: P. &, f 6 <br /> Contact Person: r 7-61— I P / <br /> Physical Address: ND Gt6 Phone: (Za j (90 <br /> — —__t V 4&mow/ City: G lL Zip Code: SZd <br /> Mailing Address: o Gf?n <br /> City' ��7X ff kupj Zip Code: 9,F20 I <br /> E. DESCRIPTION <br /> Type of Discharge: S e i n G n ve InN�Lo 4-c&F l o <br /> Volume: ZD Sa(l1orn <br /> Chemicals: To a'►f ��"lam` 1`1, <br /> Circumstances: be, v-( <br /> F. ACTION TAKEN: CI tart v 6 P r,+r, <br /> SITE DISPOSITION: 0O <br /> EHD 22-02-003 <br /> 10/2/2003 <br /> Notification of Fiu Discharge <br />