Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCMARGE <br /> HEALTH & SAFETY CODE 25180.7 vv r <br /> cor) <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG #. vz <br /> (Circle One) <br /> B. SOURC� INFORMATION <br /> Name: r Phone: <br /> Company:64 <br /> Address• o cPi� CA 2S-35-1 <br /> Designated Employee Name: Phone: C__) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 32',�---- -. &-," 6o- - 4) / Sfio C P2-�� <br /> (Best Physical Description) (City ooun Circle One <br /> Date of Discharge: <br /> Date Notified: Time: Yoo A.A4, <br /> T <br /> D. RESPONSIBLE PERSONN�uM.,..C�P�V <br /> SS <br /> Name of Business:77 <br /> Contact Person Telephone: O792- -Vq7 7 <br /> Physical Address: 7�ZZ. 4c-)-o-do- <br /> Mailing Address: F-0. s cx ('`J — -- CA X 5 6 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: -tu�f�� '. . <br /> Chemicals: <br /> Circumstanc � : /a - <br /> F. ACTION TAKEN G(I. P 09�Ce <br /> 17 9 <br /> SITE D OSITI N ,--,— <br /> i <br /> r <br /> EH 22 013 (Rev.4/91) <br />