Laserfiche WebLink
v <br /> SAY jOAQuliv COUNTY <br /> �t0T1FIC?.TI0N OF ELAZARDOUS WASTE DISCHARGE f L E COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> PETS-EH LOG" _ C�S� - 1 .3e <br /> A. EMERGENCY LEVE • I it lz one) <br /> B. SOURCE Of INF'OR:\IATION <br /> Name: Phone: ( ) <br /> Company: <br /> Address: Phone:- <br /> Desi d Employee Name: <br /> Reporting agency Name: <br /> Address: <br /> C, LOCATION AND DATE OF DISCHARGE <br /> Location: C_J r County) Circle one <br /> (Best Physical criptio4) <br /> Date of Discharge: <br /> Time: <br /> Date Notified: <br /> D. RESPONSIBLE PERSONMUSINESS <br /> Name of Business: *' �" <br /> Phone: 3 <br /> Contact Person: <br /> E __1 <br /> Physical address: <br /> Mailing address: <br /> E. DESCRIPTION g cd <br /> Type of Discharge. 0. <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> • 1 <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 0l3 (Rev. 03120193) <br />