Laserfiche WebLink
`, SAN JOAQUIN COUNTY �� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # - �] <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: ,! � i✓F Phone: (Z�) 348-7 <br /> Company: <br /> Address: <br /> Designated Employee Name: kleI6 - - Phone: <br /> Reporting A ency Name: <br /> Address: O �-r1 ZOi7 �'7a'G�7b1�I <br /> C. LOCATION ,?D PATE OF DISCHARGE <br /> Location: <br /> (Best Physical D scri 'on) Ci or County) Circle One <br /> Date of Discharge: 7 CX <br /> Date Notified: 74_6 G L Time: 4f <br /> D. RESPONSIBLE PERSOjV/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: ( L'2) <br /> Physical Address: Zyoo L S <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> volume: ^- 2 6z rz� <br /> Chemicals: <br /> Circujmstan es: &4116 le,�� <br /> ° [ecs c7 �- -7 (,�llLYrS <br /> C,(] a Z C LlarS SfLY/nc1 off Gv4G S!Jf—dzoct^-� /°crcra2rH "" -f�G �� SuNyo <br /> F. ACTION TAKEN /y/ �C /Y�/ VowJ�d ori <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />