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° Pq�utN <br /> SAN JOAQUIN COUNTY —( <br /> E c°c <br /> Q i ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y N <br />' 600 East Main Street Stockton • CA 95202-3029 3420 <br /> (209) 468M3:5;I <br /> - • Fax: (209) 464-0138 • Web: www sieov org/ehd <br /> 9�/ORN�P ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE r . <br /> � r � 7N4 v !Y ` <br /> A. EMERGENCY LEVEL % I H <br /> EHD LOG# <br /> B. SOURCE OF INFORMATION <br /> NAME: C C 1. <br /> I t1 a PHONE: p g 4G 8 - 98 s'2 <br /> COMPANY: E- H <br /> I CITY. Si'0C �(-�-0 h <br /> ADDRESS: (n O D E • Mk i `r/l STY e e <br /> DESIGNATED EMPLOYEE NAME: y t r fk Y-Fri PHONE: �' a q <br /> REPORTING AGENCY NAME: S yl <br /> r0 �Q <br /> ADDRESS: Q � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: r <br /> &r Phr&cd a,anp000 G Z 3 0 �! Qe ;'Y; (� Pt %f CITY <br /> Sto Gk�-n.� c° rated <br /> DATE OF DISCHARGE: Uninc° orated <br /> /9� 8 - � DOZ Vtlknowr1 <br /> DATE NOTIFIED: <br /> TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: C E S <br /> CONTACT PERSON: � <br /> HYSICAL ADDRESS: e YYL O �7 e <br /> // PHONE: d Q!J <br /> P <br /> ve , 20 <br /> MAII,ING ADDRESS: � 3 / 1U <br /> - E. DESCRIPTION 7 '� <br /> TYPE OF DISCHARGE: A <br /> VOLUME: <br /> rl <br /> CHEMICALS: Grad' � <br /> CIRCUMSTANCES: UST 5 -Aem ' sI'0. es show el re re �c. `la do Y . 'f'1� reJ uJRs 'Pf� e oi- iuse <br /> P. ACTION TAKEN s Ca r�r n a'F s o i l a t�c.fr� F _ I a <br /> y felfGro{afeo( G Mares 2017 / `rhe. & HDdirc�F�( yG � solom <br /> -Pet? 5ib ;/ V s�voJc or CV d4'h�cq a laf;+ional r� mec✓% 'o2 Q � irr �Q eof <br /> � ro Q �a� ct a/an/c� Id,l to Cance/a e Sze 14�dre l o(elin i` a � <br /> �ro vWO&) <br /> SITE DISPOSITTON <br /> this s ;fe is art Loyosi` t., � ]7r iY�� �Yvrh t172c_ Cl / J� jylLv � <br /> lea n / n o-real. Curr �t��7`i vn r6„Ly y rnva t be <br /> /nv l f i n �liiJ �i�e bei rPr/ caC -far <br /> ER RECORD MODIFIED <br /> Revised 05/012007 <br />