Laserfiche WebLink
GQ-�- <br /> �- SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: <br /> II III PHS-EH LOG # �v / <br /> le One) <br /> B. SOURCE OF INFORMATION <br /> Name: r'/1 Phone: <br /> Company: o� ' Cao r cC �dy <br /> Addresse- 0- ,�0 <br /> Designated Employee Name: 3 / Phone: (2LL) b -0 <br /> Reporting A cy Name: Loggtv,1 L 4 <br /> Address: 0 ;-�o i <br /> C. LOCATION AND DATE OF DISCHGE <br /> Location: /-7/-7 .J . �'rh . <br /> (Best Physical Desc 'ption) Ci or County) Circle One <br /> Date of Discharge: . (nil Oc�rn. <br /> Date Notified: Time: -560 <br /> D. RESPONSIBLE PERSON,/SUS NESS L <br /> Name of Business: S�/ff'7 da✓�( <br /> Contact Person:61-Uezygw 6-4* Telephone: CLD_27y-LaG y <br /> Physical Address: /3ok�4/. D16/1,.izkaz D-1, 4��is "as 9sav7 <br /> Mailing Address: /30Yui• /cofsin/i�19� �� S /cam P� 9s'as) <br /> E. DESCRIPTION /_ /� <br /> Type of Discharge: Zea l <br /> Volume <br /> Chemicals: AA /G <br /> Circumstances: S <br /> F. ACTION TAKEN UST amyoy 561,2a) OASf,40;¢� <br /> SITE DISP SITION <br /> LG <br /> EH 22 013 (Rev.4/91) <br />