Laserfiche WebLink
lfb/Id1,l-jd 14: `! 1 UX I C SUSSTRNCES CONTROL 3 912094640138 NQ.28r W02 <br /> �r <br /> 046�te of Ceti7pTfe--California 1anviroAmeattl Protwilen AQ`ney GoparlmdN at Ta.io substarean coarol <br /> COMPLAINT REPORT FORAM <br /> (testi ball-point Pott) Log Nrnnbar: <br /> INFORMANT :', ALLEGED RESPOWSIBLE RESPONSIBLEPARTY <br /> ,,ii ` <br /> <br /> <br /> <br /> <br /> <br /> ` PERMIT/ SERVICES <br /> (� Confidential CA Q Anonymova: whack ant,) County Code': J .Phone ( ? <br /> i�. COMPLAINT DATA <br /> 1 <br /> Is this an emergency? a Yea 5L No yea, call the Office of Emwgoncy Servicea(0153): 800.852•75W <br /> Log Kan+ber:�Date Counp1alrtt Time: #tecefved R3r: - -- --- <br /> Notifications made (Yea/No)Prop_ 85 ,�o D Local Agency - Who? <br /> ii . <br /> Dote of Incident: Y� ?•1 7"�' --- A4169attenCade�. Quantity:. �- <br /> type/Gondition of Containare Viaible: <br /> Source of C0mpia1nt1Code0. - If Cada,k Specify: -- -- -- <br /> other Comments: S-Orizi4 tj 1i&A41!!tt "T &kG ...- <br /> 11 <br /> � cls ,�ars. �• ,A � <br /> jr= <br /> [i <br /> a rata rx,�.rt 11aV ate . i c a to A4Ar <br /> eco <br /> COMPLAINT COORDINATORS ONLY <br /> .i <br /> Reapont:e Coale�: Rti!pfun fAgeney Referred Too <br /> JrA %ftin— <br /> II m <br /> Rouponso Data: frivee ; <br /> tlgerarr Date Annigned: <br /> II <br /> Note: lnfa"ReSon to ba Iranrclermil to eompleinI log ie highli0hted In bold flatic print_Attach an addanqurn If necassafy. <br /> n Sim cCda On revere aide. <br /> �h <br /> Whit--ReglannlOffice Yalinw---4_00 Pink—irtwestigstions Qreelr--iflformant <br /> DTSQ look(1019"1 <br /> (Ftwwwrly DH8 13281 and 061$0073) B6 97006 <br /> q <br /> I <br />