Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC PyHEALTH & SAFETY CODE 25180.7 Va <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 4-n� .6Ouac. Phone: ( (b) QLF -3306) <br /> Company: e5We 4/ <br /> Address: /f9 3 N —Aia,� %41""" S411c, 6.-0 40S03 K-/9IV3 - <br /> Designated Employee Name: Phone: C_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE O,F DISCHARGE <br /> �/ <br /> Location: U/ GZC.IuL , / �Ydn <br /> (Best Physical Description) oCi r County) Circle One <br /> Date of Discharge: <br /> Date Notified: OS-06 —94, Time: /2'00tioov <br /> D. RESPONSIBLE PERSON/BUS/I�NESS <br /> Name of Business: /iCO.6u <br /> Contact Person: U Telephone: ob 53-/Y99 <br /> Physical Address: <br /> Mailing Address: PO, 'SC 6/2-530 9�/6/ <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: c--f' AL,1— U G T <br /> F. ACTION TAKENr/) A c <br /> Q�u�v ah i? sl da <br /> 2 <br /> a� <br /> SITE STATUS <br /> U <br /> EH 22 013 (Rev.4/91) <br />