Laserfiche WebLink
SAN JOAQUIN COUNTY �J <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 cc <br /> `; 11:-� L <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # V <br /> (Circle One) <br /> B. SOURCE OF INFORMATION phone: t %5 a fl 3 -S3 <br /> Name: _ <br /> Company: ` a <br /> Address: $3 �� '9- phone. L� <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISC^HARGE� <br /> Location: 4`4 q-1 C am �a ' / (City o oun ) Circle One <br /> (Best Physical Description) <br /> Date of Discharge: <br /> Date Notified: 1 1 - ? 9 (, Time: c O e <br /> D. RESPONSIBLE PERSON/BUSINESS 1���ren CT <br /> Name of Business: !:1X Y Ao Tele hone: 1 R B U 33 <br /> Contact Person: � <br /> Physical Address 1A=4'42 a `� <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: le <br /> Volume: na kL „`- <br /> Chemicals: <br /> v <br /> Circumst ces: <br /> F. ACTION TAKEN �A <br /> SITE STATUS sn L <br /> GL A tr 1 <br /> EH 22 013 (Rev.4/91) <br />