Laserfiche WebLink
} <br /> SAN JOAQUIN COUNTY -.. - <br /> o. o NTAL HEALTH DEPARTMENT ( ° <br /> ENVIR O 1 <br /> Avenue,3`4 Floor, Stockton,CA 95202-2708 <br /> 304 East Welaer Av , <br /> '(209)468-3420.Fax: (209)464-0138= lye <br /> b:w�vw.co.san 3oaquin.ca.ttslehd <br /> CATION OF HAZARDOUS WASTE DISCHARGE <br /> Safety Code, Section x5180.7 <br /> � l ._. ... California Health & Sa y <br /> EAD LOG 4 <br /> A. EMERGENCY LEVEL: I II <br /> (Circle One) <br /> B. SOURCE OF INFORMATION ' Phone: ( ) <br /> Name: <br /> Company: City. Zip Code: <br /> Address: <br /> Designated Employee Name: <br /> Reporting Agency Name: Zip Code: �. <br /> City: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE it r Count <br /> Location: ircle One) <br /> - (Best Physical Dcscription) _ . . <br /> 1 2 Time: <br /> Date of Discharge: l0 <br /> Date Notified: . <br /> D RESPONSIBLE PERSON/13USINESS n <br /> Name of Business: �.a�� <br /> Phone: ( ) <br /> Contact Person: City: Zip Code: <br /> Physical Address: �. Ci ,,,a Zip Code: <br /> Mailing Address: �• � � �ag -• ��� ��-� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> D <br /> -Volume: , <br /> Chemicals: V J + <br /> Circumstances* <br /> \ A- <br /> c .o�,tN 5V <br /> F. ACTION TAKEN: 0 ra41 <br /> s <br /> SITE DISPOSITION: <br />