Laserfiche WebLink
SAN � DUNTLY <br /> YONMENTAL HEALTH DEPARTMENT <br /> East Weber Avenue,3`d Floor,Stockton, CA 95202-2708 <br /> 68-3420•Fax: (209)464-0138. Web:www.co.san-joaquin.cams/ehd <br /> F <br /> OTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> California Health & Safety Code, Section 25180.7 <br /> 0 <br /> EHD LOG#: C <br /> A. EMERGENCY LEVEL II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: D e.n n t S Ca as n Phone: (.a09) 33 3-6� <br /> Company: <br /> Address: �. t n, City: Zip Code: q 5�f 0 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: I / Cit or Count <br /> (Best Physi al Description) (circle One) <br /> Date of Discharge: t�h k--��►'� Date Notified: 3 3 05 Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: <br /> Contact Person: t 2r►n Phone: ( 4) <br /> Physical Address: <br /> Cit Lo Zip Code: 95.2 q D <br /> �3a E(m y' <br /> Mailing Address: <br /> City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge:.— <br /> Volume: <br /> ischarge:Volume: W <br /> Chemicals: T <br /> v t eu1 o a l Sa1'r- owl <br /> Circumstances: s <br /> Q IP S <br /> F. ACTION TAKEN: <br /> SITE DISPOSITION: OX r <br /> Notification of Haz Discharge <br />