Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> IL <br /> ill! <br /> A. EMERGENCY LEVEL: I II III PHkH LOG # <br /> (Ciircle One) <br /> i B. SOURCE OF INFORMATION <br /> Name: �P. n� Gbh 4c� .ScT Phone: ( - <br /> Company: <br /> Address: <br /> 30c/ <br /> � C cry c.'n 11 <br /> Designated Employee Name: / Phone: (2LcD Y6,P <br /> Reporting Agency Name:. J' � <br /> Address: <br /> i <br /> !r <br /> C. LOCATION AND DATE OF DISCHARGE '` <br /> j Location: 30 VA.), .4c 4,:e C r;;r_ 1� / v 7 a9 <br /> 1 (Best Physical Description) i' City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: !o Time: <br /> I <br /> i D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: „ A;,'04 Gly eXLL L Acy/ 121r�rc 7 _ <br /> Contact Person: vP �'/ Telephone: [��? 9- 3l <br /> Physical Address: <br /># Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: a&f y�vr•��� ' <br />+ Volume: ft. <br /> Chemicals: <br /> Circumstances: ;/ / ¢ ti c 'h d �'v � � All <br /> o <br /> r - ;' <br /> F. ACTION TAKEN a a.,,,►� ,� / <br /> h <br /> �1 <br /> �1yy <br /> 4 <br /> SITE DISPOSITION_ <br /> P C tjmrr,i irx-v fi a �. C <br /> iI <br /> a <br /> .I <br /> EH 22 013 (Rev.4/91) <br />