Laserfiche WebLink
�.. SAN JOAQUIN COUNTY u` <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE . <br /> HEALTH & SAFETY CODE 25180.7 <br /> r^ <br /> A. EMERGENCY LEVEL: ,�`I� II III PHS-EH LOG # U ©� <br /> I Q cle One <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: 5,'4 <br /> Reporting Agency Name: LL-L{, Ce�v'�'^ <br /> Agency Contact: Telephone: ,) <br /> Address: LI j �-� fi—� A,v <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1-:31 . 0� -i-- � / _ C+f/-� _— <br /> _ T <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: { ✓��{�'� <br /> Date Notified: �j(��CrL? Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business" <br /> 4tit,�i> Contact Person: 0-+-7;�r�,r, t �t?N Telephoner (_(� 4 2 -�G�Cc�?.C_Q <br /> Physical Address: Z'( U, r2(yQ no 1?C1 ✓r,c-�� �. ��_�� �� Cr4 ct y y-"z C � <br /> E. DESCRIPTION <br /> Type Release: -(2121 ,rn,-n,rrY3 �- r, r�+n nd2� `t /��+i ,�� r I <br /> Volume: t t t/-I G'�� , , <br /> Chemicals: <br /> F. ACTION TAKEN <br /> In <br /> V-0+1�tf�, 0—/X-"-v/Il_ <br /> EH 22 013 (Rev. 02/90) <br />