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Ulm p SAN JOAQUIN COUNTY ip <br /> r.. ? E&RONMENTAL HEALTH DEPAR*NT D <br /> 600 E. Main Street, Stockton, CA 95202 (p <br /> (209)468-3420-Fax:(209)464-8392• Web:www.co.san-joaquin.ca.us/chd <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR ��.�•,�.1 ' <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: &off�1-rxv 161- Phone: (S�) 3ySs-Zzco <br /> Company: XVICA' iv. `I A-55acLAA- ec <br /> Address: Z s Wist poi ko4rvs Ave.City: eJ oyi5 Zip Code: y 36i7 <br /> Designated Employee Name: I-QV- i K t 2A2 .t) <br /> Reporting Agency Name: vt <br /> Address: /nor) P-rxST ".0N) S4City: Zip Code: !2 2_ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: za 11 e_F2�ntdnrtS'h • .S12gry N / rtvlorCounty <br /> (Best Physical Description) cle One) <br /> Date of Discharge: tw"owA) Date Notified: I Time: A.M. PM <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: 0nl Mf:-1 O (L�n1TPdS <br /> Contact Person: W ArI ME kizE:N)&�j Phone: ( ) <br /> Physical Address: Zq 1 t -G&EMM0rV71' City: ST K-jam Zip Code: <br /> Mailing Address: P06c TZz1 City: vkm rl e–s '�"� Zip Code: JQ2 <br /> E. DESCRIPTION <br /> Type of Discharge: Un\cuAl cn qgz w c fit1 i1,A5S S/ <br /> Volume: (A-7kAA©c,)L--\ <br /> Chemicals: (gnsQ(�rs-x <br /> —r <br /> Circumstances: <br /> F. ACTION TAKEN: CS.- P^)r"�<Q l r,Inr9 Z1A 641�f , EIA'6 _ <br /> Ulkrkff not d t J A S PJ .o n,k� <br /> SITE DISPOSITION: St-} (4,enr O,, cn=n, A A u�� cl�p (4 A> <br /> EHD 22-02-003 Notification of Haz Discharge <br /> 05/04/07 <br />