Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC-IARGE <br /> HEALTH & SAFETY CODE ZS180.7 <br /> A. EMERGENCY LEVEL:I� III PHS-EH LOG T �v J ILL) <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: .C2i� <br /> Company: Phone:Phone: _cJd.�-o5s� <br /> Address: <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: Z z= <br /> C. LOCATION AND DATE OF DISCFARGE Y <br /> Location: 7-W /25I JC 7—/ 1-{1yAA MAIC / Loor <br /> (Best Physical Des <br /> Dare of Discharge: �� - ( °r Co Y) C rc'.e One <br /> I 1 <br /> Date Notined: Time: <br /> D. RESPONSIBLE PE.RSON/BUSIl�IESS <br /> Name of Business n.�41- oS .gyp. g <br /> Contact Persoa De, Telephone: z 333-ioa6 <br /> Physical Address: Z +vgrrt�,w+: e <br /> 9 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Vclume: aN <br /> Chernicais• <74o <br /> Circumstances: so, Gon'�/5'/r �D urS S-L`Z^✓ ('fin <br /> '7T-IRS+6,-� ::2 K <br /> F. ACTION TAMN I/ <br /> SITE DISPOSITION 2 0l« v�C�i n lin <br /> wo; c�c� r� i• T <br /> EH 22 013 (Rev.4/91) <br />