Laserfiche WebLink
SAN JOAQUIN COUNTY }� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 'IJ <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # q <br /> ( 1rcle One) <br /> B. SOURCE OF INFO TION <br /> Name: Phone: til S � <br /> Company: Z <br /> Address: — ti, d lr G Z-- <br /> Designated <br /> Designated Employee Name- It to Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION ANDDATE OF DISCHARG��yj <br /> Location: HL}I <br /> (Best Physical Description) , 7 (City r County) Circle One <br /> Date of Discharge: / <br /> Date Notified: /Z IL Time: Do pm <br /> D. RESPONSIBLE PERSON/BUSIN SS <br /> Name of Business: o <br /> Contact Person: L2oukjeytZTelephone: ZO9 943 - 02-96 <br /> Physical Address: W, LL r 44 '2 <br /> Mailing Address: wn.2 <br /> E. DESCRIPTION / <br /> Type of Discharge: _ y` c7 LQ P -ri"6M GGA c i/✓ <br /> Volume: - <br /> Chemicals: <br /> Circumstances: dA <br /> F. ACTION TAKEN <br /> Zri i;Li /a,l�a•�.c.Q.¢e't i.� /�� � (taffy <br /> SITE DISPOSITION 04Al <br /> v17 <br /> All <br /> EH 22 013 (Rev.4/91) <br />