Laserfiche WebLink
TY <br /> SAN JOAQUIN COUN �( <br /> NOTIFIC;1 ON OF HAZARDOUS WASTE DIStkARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # U� <br /> ( ' cle One) <br /> B. SOURCE 0 ORMATION <br /> Name: / Phone: (2-1-0 6 70 <br /> Company: - <br /> Address: --Q- <br /> i, ,� 0 70 z- - 03 <br /> Designated Employee Name: � Phone: <br /> Reporting Agency Name: a N <br /> 60. <br /> Address: aji S/ <br /> C. LOCATION AND ATE OF DISCHAP <br /> Location: o <br /> (Best Phys al Description) ZRV V i or County) Circle One <br /> Date of Discharge: O <br /> Date Notified: 7 I]Lfz .S- Time: / :/ -9 Prl <br /> D. RESPONSIBLE PERSON/BUSINEP <br /> Name of Business: r• ,Q ti c <br /> Contact Person: /L• / Telephone: (7W ( 70— <br /> Physical Address: <br /> Mailing Address: ,.4 c) 6 vb 6 03�-7 /Q r iu C*+ S o 7 v <br /> E. DESCRIPTION <br /> Type of Discharge: �N Volume: <br /> Chemicals:Chemicals: <br /> Circumstances: �^- <br /> 6r``` <br /> F. ACTION TAKEN u • �" <br /> �„,ctidl �Sa.r S <br /> SITE DISPOSITION— rj 00 - <br /> gjad— <br /> EH 22 013 (Rev.4/91) <br />