Laserfiche WebLink
SAN UIN COUNTY ,,... <br /> NOTIFICATION OF HAZARDOUS E DISCHARGE <br /> HEALTH & SAFETY CODE 25180 7 <br /> A. EMERGENCY < III PHS.EH LOG <br /> (Circle Orae) <br /> SOURCE OF INFORMATION <br /> N Phone: . 4 <br /> Company:,,::::,,::;;,,,,, <br /> Address: _t <br /> Designated Employee N Phone <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 5 <br /> est I hysi ri ti r , <br /> Date of <br /> Discharge: <br /> Date Notified: <br /> °` <br /> (C t3�— oun Circle One <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: � <br /> Contact Person: I r e " <br /> Physical d st <br /> Mailing Address <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> s„,Volume:q <br /> mal& 'cats: to <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION, <br /> EH 22 013 R9 <br />