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° SAN JOAQUIN COUNT? 5 5 O I I�11 <br />?` ENVIRONMENTAL HEALTH DEPARTMENT <br />N < <br />600 East Main Street Stockton • CA 95202-3029 <br />(209) 468-3420 • Fax. (209) 464-0138 • Web: www.sigoV.ore/ehd <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE iJ <br />A. EMERGENCY LEVEL x6I'll 17-1 EHD LOG# 1_ Q <br />B. SOURCE OF INFORMATION <br />NAME: <br />I G <br />PHONE: <br />LO l b <br />COMPANY: <br />Inco rated <br />CITY: <br />Unmco orated <br />ADDRESS: <br />S O <br />DESIGNATED EMPLOYEE NAME: <br />I &f'411 I7 <br />e\ <br />PHONE: <br />0 0 <br />REPORTING AGENCY NAME: <br />ADDRESS: <br />W�1 <br />C. T.00A77nN ANTI T)ATP !TR T)TWPARnA <br />LOCATION: <br />eev �ricm Dexn�w <br />1 4 f_"T,`' -(7,-P' � <br />C <br />IiA <br />CITYn <br />LO l b <br />PHYSICAL ADDRESS: l Gt <br />Inco rated <br />MAILING ADDRESS: <br />Unmco orated <br />DATE OF DISCHARG <br />S O <br />DATE N07TFIED: <br />I &f'411 I7 <br />TIME: <br />l 1 <br />D. RESPONSIBLE PERSON/BTTSINRY; <br />NAME OF BUSINESS: <br />CONTACt PERSON: LX4,r <br />PHONE: <br />LO l b <br />PHYSICAL ADDRESS: l Gt <br />2,0 S <br />MAILING ADDRESS: <br />E. <br />TYPE OF DISCHARGE: <br />VOLUME; <br />CHEMICALS: <br />sk k vtvn, X10}- �u( out fire w/ �aa�vt f re t.v�i r�e�i vn m a i., l K zt wk- o� <br />WW oil �+ ondw gs P -&L � gat- -4&4, 6F vfmk treL(c�li� hark <br />Will be SOW Pe& d$ . 10L td6V- k4e+- i�-;{- is u646e. <br />20cr <br />&4'rofs"n sKor n.VV`ar w, "i/+ a4- y , a,l sub- 0 sw <br />n*r will ELvnq m� 44v Mrd 4w siert- 5605aA- of- w <br />fu�1 s�illel tm .501 'Al be rtmOVIM <br />qmT k Stom 6igio i op6. (AeAovp W Aw, -today <br />,plo*(, fxv�k. <br />tyle ay\fi-1 r eaz2 ) , <br />i5 l- 1�0 p <br />ER RECORD MODIFIED Revised 05/01/2007 <br />