Laserfiche WebLink
�o. `�"'"•co SAN.JOAQUIN COUNTY <br /> a Gya EN MONMENTAL HEALTH DEPARTl";NT <br /> y 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> �qG P <br /> (209)468-3420•Fax:(209)464-0138 • Web:www.co.san joaquin.ca.us/ehdF C <br /> PORE .0 P Y <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> EHD LOG#: 04- D <br /> A. EMERGENCY LEVEL: I� H III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION�� <br /> Name: <br /> V Phone: (vj) 7 - So69 <br /> Company: C I S <br /> Address: City: Sc/ o Zip Code: <br /> Designated Employee Name: A T <br /> Reporting Agency Name: S Jam u• Co�- i u ��w� J y <br /> Address: -(:;4 City: vcl -,• Zip Code: 7 5' ?C'Z <br /> C. LOCATION AND DATE 9F DISCHARGE <br /> Location: U �� Ge 2 "itr Count <br /> (Best Physical Description) cle One) <br /> Date of Discharge: Chu K!2,rhn!� <br /> Date Notified: Time: A.M. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: 2*n- , <br /> 7 Phone: (tis) 277- S'e%9 <br /> Physical Address: Z • - EGA<a/o _City: Sf����t Zip Code: 9S`z o Z <br /> Mailing Address: City: � Zip Code: <br /> E. DESCRIPTION �/ <br /> Type of Discharge: 2 . .u C � <br /> � <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN: <br /> SITE DISPOSITION: <br /> Notification of Haz Discharge <br /> EHD 22-02-003 <br /> 10/2/2003 <br />