Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> C(O <br /> PY <br /> HEALTH & SAFETY CODE 2518U . 7 <br /> q <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT 'LOG #`�5 -� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: r1,1- ._LCIS%elcl <br /> Agency Contact: Telephone: <br /> Address: 0 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ) <br /> Date Notified: 3lL/���_ _ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> L <br /> Name of Business � - <br /> Contact Person: ��,(�,¢�ji _ Telephone: <br /> Physical Address: <br /> T". <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals-.. <br /> F. ACTION TAKEN <br /> g(-,f/ 112 .5/� �3GxidLt <br /> . � <br />