Laserfiche WebLink
„,. SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:�II III LOG # (o U <br /> (C'i'rcle One) 00F7 <br /> B. SOURCE OF INFORMATION <br /> Name: .TAc_tG R fq5 H Fit Phone: (2C 5�-3,0 V <br /> Company: ro T' z7r5 <br /> Address: -Z� Y E 1 1 S '' . <� g S 3 7 <br /> Designated Employee Name: // Phone: C&�D #,6 <% <br /> Reporting Agency Name: SAM <br /> Address: Q 0 , TO x �O D 4 C�v c�T6 re e-^ 95 7�t7/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Zd g E I ei 5 /?��'� / �iZ/►Z�� c6S'3 <br /> (Best Physical Description) (City ori ounty) Circle One <br /> Date of Discharge: V 0 1- vo <br /> - <br /> Date Notified: -7- I -i -!�j I Time: ' o o <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: rkACv NUTO - PA'eTS <br /> Contact Person: H2 Telephone: <br /> Physical Address: !7f9 V E <br /> Mailing Address: n 4 cn-/ ' -0 5 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: U I,, Ic_r. nJ <br /> Chemicals: c.”. 6 O� <br /> Circumstances: 0,< C L 50-# p16 <br /> y <br /> F. ACTION TAKEN A(c," �l S 0 H� T7 t N iiv <br /> -2/� <br /> el Jrz.✓ o F <br /> r <br /> SITE DISPOSITION---�-7(LK� be- <br /> -�z'+-r1�t„-- o 17-- c 0,.� Ft n., �l a.Tc�.J _ r-��-, <br /> EH 22 013 (Rev-4/91) <br />