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SAN JOAQUIN COUNTY r; <br /> EI A:RoNMENTAL HEALTH DEPARTMENT <br /> 600 E.Main Street, Stockton,CA 95202-3029 <br /> Tekphone.(209)468-3420 Fax.(209)468-3433 Web.www.sjgov.org/ <br /> NOTMCATI OF HAZARDOUS WASTE DIS <br /> California Health&Safety Code,Section 25180.7 <br /> EHD LOG#. D -571 <br /> b <br /> A. EMERGENCY LEVE�J' 11 in , <br /> (Circle Ono) a <br /> B. SOURCE OF XNFORMATION <br /> Name: Phone: (49 <br /> Company: es zjj� <br /> Z Code: <br /> { <br /> Designated Employee Name: VV <br /> Reporting Agency Name: <br /> Address: L j*e o.t _ . :City: Zip Code: <br /> C. ,, LOCATION AND DATE OFDISC G <br /> . �1� . <br /> Location: , •� / City o Com <br /> (Rest Physical D=ripbim) (Circle <br /> Date of Discharge: -11A Ljd,4nd2)A_Date Notified: Time:', <br /> D. ' RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: o�r— -A A)n AM= <br /> '' <br /> Contact Person: AGL Phone:(47) <br /> PhysicalAddress: City: -� t,C:, , —Zip Coyle' <br /> Mailing Address: City: Zip Code: <br /> I <br /> E. DESCRIPTION <br /> Type of Discharge: �L, <br /> Volume: <br /> E Chemicals: <br /> C. �,�.. <br /> F. ACTIO TAKEN: ' <br /> i1302raC <br /> SITE DISPOSITION: x' y <br /> EHD 22-03 Notification of Hu Dis mVp <br /> 11Rb200'� <br />