Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFI�TION OF HAZARDOUS WASTE DI "HARE <br /> HEALTH & SAFETY CODE 25180.7 . <br /> s <br /> � I <br /> A. EMERGENCY LEVEL I II III PHS-EH LOG # <br /> ( ucle One) <br /> B. SOURCE O IN ORMA ION w <br /> Name: r k;&Ze 14k Pho e: (_'2v'h 83 F-3-Se-7 <br /> Company: <br /> Addr`e'ss: 171v <br /> Designated Employee Name: . - __ Phone: <br /> i Reporting Agency Name: <br /> Address' <br /> i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> f Location: Z360 E'sT .5,7 eE: <br />! (Best Physical Description) <br /> . Ci or County} Circle One <br /> Ys P <br /> Date of Discharge: UN <br /> Date Notified: _ 8z 5 Time: !D_'ao <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: -5' i✓ <br /> Contact Person: ES Telephone: QLZD .3S-3zo!o <br /> Physical Address: 23/a I 45_37 (, <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: UN <br /> Chemicals : <br /> Circumstances: <br /> F. ACTION T N <br /> i <br /> Q.Js t.eACAa{ <br /> SITE DISPOSITION °1 <br /> EH 22 013 (Rev.4/91) ;::;, <br />