Laserfiche WebLink
A. <br />C. <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 C Py <br />EMERGENCY LEVEL: ( II III <br />(Circle One) <br />SOURCE OF INFORMATION <br />Name: YbA <br />Company:_ PAP, <br />Address:__'711L s. s� <br />Designated Employee Name: <br />Reporting Age Name: <br />Name: <br />Address: zc ; wEa? <br />To <br />PHS -EH LOG # <br />LOCATION AND DATE OF DISCHARGE <br />Location: 91412 s ,s i o-�-a�J S77: / <br />(Best Physical Description) <br />Date of Discharge: i <br />Date Notified: I L— /& 5 Time: - 3 00 4,.•-, <br />D. RESPONSIBLE PERSON/BUSINEISS <br />Name of Business: <br />Contact Person: G{oB,g,ez,v�.4 oe <br />Physical Address: qW Z- s . s <br />Mailing Address: 9yZ 5. s�-E <br />E. <br />F. <br />DESCRIPTION <br />Type of Discharge: <br />Volume: , 2,yoo <br />Chemicals: <br />Circumstan, <br />Phone: (Zz-�.) sti9 - oz �S <br />Phone: �) <br />1 a <br />Ci _ r County) Circle One <br />Telephone: (Z,,,!�) s'S� -oz75 <br />WIN <br />ACTION TAKEN_ <br />SITE DISPOSITION --,I I-.-$.., -A, G.__ -- -- - _ _ -- <br />EH 22 013 (Rev.4/91) <br />