Laserfiche WebLink
n SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 'II III PHS-EH LOG #(L ,�-� <br /> (C1r'cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: C- C_ l �., L�.% Phone: C;L3:o 94-.a -Cl Y; <br /> Company: „o 0 S"77 <br /> Address: -' <br /> Designated Employee Name:' Le±L Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1500 A). S A ua () I <br /> (Best Physical Description) , (City or, oun Circle One <br /> Date of Discharge: _Gr,I-? c`Z"L Yti <br /> Date Notified: — ! 7 — Time: /C ' 0- 0� 'JA <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: � � : ; ��� / C '�i�_�-c- Telephone: u'.- 770 G <br /> Physical Address: J inn ' <br /> Mailing Address: CCe rne- <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: a z�'ir� 6 c'viJ <br /> Chemicals: SG�tir= <br /> Circumstances. ha 4-r <br /> Ce�rLb/�YYLvi Cr �GliG2��✓. �° i�Q vY 4L c�@ 4 Ctv,c.a, <br /> F. ACTION TAKENi i, (n /a)r I + s,�n ��[Z gt;co <br /> ti <br /> SITE DISPOSIT��I��O``N <br /> a— C1a L <br /> EH 22 013 (Rev.4/91) <br />