Laserfiche WebLink
SAN JOAQULN COUNTY* - �LJl�- <br /> NOTIFICATION OF HAZARDOUS WASTE DIME1 COPY <br /> HEALTH & SAFETY CODE 25180.7 rr ����C%Q <br /> A. EMERGENCY LEVEL: I II PHS-EH LOG ! 6 O�� <br /> (Circle one <br /> B. SOURCE OF INFORMATION <br /> Name: � Phone: (Ml S"'2-O q O O <br /> Company: C= <br /> Address: 14C7' <br /> Designated Employee Name:JbftL Phone: <br /> Reporting Agency Name: V <br /> Address: 3044 'E AVS (7, <br /> C. LOCATION AMD DATE OF DISCHARGE <br /> Location:515! RLPIO N NV.`, b DTZ- mftKECA <br /> (Best Physical Description) < ity or County) Circle one <br /> Date of Discharge: <br /> Date Notified: Time: <br /> / D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: -ROY Z1 <br /> Contact Person: �r.`,1 -u Pr Wl (+A-2R-L-<, Phone: ZO9 E 1a6 I <br /> Phvsical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: 5M Y L REI\;?-Z V 5 <br /> Volume: <br /> Chemicals: <br /> Circumstances: n n <br /> F. ACTION TAKENI � � n� �t urc1LX <br /> SITE DISPOSITION Yc�45bLp�A _ gr�binn <br /> EH 22 013 (Rev. 03/20/93) <br />