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SAN JOAQUIN COUNTY <br /> o� <br /> 2 , IRONMENTAL HEALTH DEPAR . ANT <br /> M m 600 E. Main Street, Stockton, CA 95202-3029 <br /> a P Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd 1. ki <br /> t/FOIR <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHA G a <br /> California Health & Safety Code, Section 25180.7 p <br /> �^� EHD LOG #: <br /> A. EMERGENCY LEVELS I ) II III <br /> 0 (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 8 ! 6k fie U � Uri5y Phone: (70�7 ) &6qo OP PO <br /> Company: jZ D J� 2tJ E n S i '1 eer! nS C2rvi LeC <br /> Address : t-{ L10ArrStrtJ AL)R . City: 2DLNer AA-PKZipCode: 9 "1900 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2159 S , S C bot " IGhlD j / Ci r Count <br /> (Best Physical Description) trcle One) <br /> Date of Discharge: UN krt v" Date Notified : S 3 U Time: : 3 �. �o"� P.M. <br /> D. RESPONSIBLE PERSON/BUSINESS n <br /> Name of Business: Rc�`, 1,- 4 � b Qvk4 ftp G P <br /> r , S . I'/� <br /> Contact Person: R 0 zP:f A N n2rl�ooJ Phone: ( ) <br /> Physical Address: City: Zip Code: <br /> Mailing Address : 1 S58 5 ( q% C{ City: 041 le / -lk Zip Code: VZ I <br /> E. DESCRIPTION <br /> Type of Discharge: !:� Mlt'dYl. K& L4 Yom. <br /> Volume: U NY. rt own <br /> Chemicals : Qe /IZvnr �a � v e� , L n.Q, <br /> Circumstances: A AIn 711 E (y U1ranw/y � Z Tirf illuel <br /> F. ACTION TAKEN: � v �l y <br /> l QeSPON � i a� f 2TSd0� J :;6 f uMIa j j/LK V N tgI SVOUNO <br /> SY r -V-0* \C' re nov <br /> SITE DISPOSITION: P/ r ^ i� A I U1'} 9 lard eel <br /> CQCILtI (/DD� <br /> A014 14 o 'f o <br /> EHD 22-03 Notification of Haz Discharge <br /> 11/26/2007 <br />