Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE --,, <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # D <br /> (Circle One) <br /> B. SOURCE OF INFORMATION. <br /> Name: r��/^ /sig �i G'f'� <br /> Phone:) <br /> Company: . <br /> Address: / <br /> Designated Employee Name: y, Phone: <br /> Reporting Agency Name: H <br /> Address: joy f– ZG�'��� CK rbc! <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: id/ ( -/- I - Z/�" / j f�)(�,l<f <br /> (Best Physical Description) <br /> Date of Discharge: or County) Circle One <br /> / �,.,, <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: �r/� ��� f�i �r Telephone: ��L I6-; <br /> Physical Address: -7o/ G' �` Din 5` <br /> Mailing Address: 70,> <br /> E. DESCRIPTION <br /> Type of Discharge: � <br /> Volume: <br /> Chemicals <br /> Circumstances: <br /> F. ACTION TAKEN_ <br /> SITE STATUSi� 44 n <br /> EH 22 013 (Rev.4/91) <br />