Laserfiche WebLink
1 <br /> SAN JOAQUIN COUNTY <br /> // NOTIFICATION OF HAZARDOUS WASTE DISCHARGE I <br /> i. HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: . I II III HEALTH DISTRICT LOG # �c <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ley., � nZ , -- Telephone: (flL) <br /> Reporting Agency Name: <br /> Agency Contact: -Qt.�z �c ,: Telephone: 5?s Zv <br /> Address: �. 'Se jyS�Ua-271 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Phy ical Description) (City or County) <br /> Date of Discharge <br /> Date Notified: / Time: <br /> �_- D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business L�-J <br /> Contact Person: batA& Telephoner Gl y <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: TJ <br /> Chemicals: <br /> J <br /> F. ACTION TAKEN';&A;, ,(_ ,<<„_1c <br />