Laserfiche WebLink
niz <br /> 4 `" JOA UIN COUNTY Z D '�- <br /> SAN <br /> oG Q <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton E CA 95202-3029 <br /> ' (209)468-3420 -Fax:(209)464-0138 • Web:www.sigov.org- Id <br /> �rF0Rr' a <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR ' s <br /> A. EMERGENCY LEVEL IXII III I 1IF1EHD LOG# —Q <br /> B. SOURCE OF INFORMATION <br /> NAME: PHONE: <br /> COMPANY: CITY: <br /> ADDRESS: <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: K—�e D <br /> ADDRESS: D C> 4�t/Y? St, CJ'34-0 Cc 500 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: CITY C/ �, r, Incorporated <br /> IfBest Physical Description ZL �� � ' {�J �C/�-� 'elr Ki0 UI/ <br /> V [ Unincorporated <br /> DATE OF DISCHARGE: 2 2 2 Q <br /> DATE NOTIFIED: 2 2Z r� TIME: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: (� I-76 <br /> CONTACT PERSON: PHONE: <br /> PHYSICAL ADDRESS: <br /> MAILING ADDRESS: <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CI-IEMICALS: <br /> I <br /> CIRCUMSTANCES: t G <br /> F. ACTION TAKEN <br /> MA <br /> Ozer- Gva_a . <br /> SITE DISPOSITION <br /> J-1�21 11 hta 4� AO a-e741b� <br /> f ER RECORD MODIFIED Revised 05/01/2007 <br /> I <br />