Laserfiche WebLink
May , 13 . 2004 1 :21PM Neil 0• Anderson & Asso, IINo 50905 IP - 91'I is <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE I S X997 <br /> HEALTH & SAFETY CODE 25180.7 <br /> OFFlCE G�t <br /> A. EMERGENCY LEVEL:Q lI III PHS-EH LOG #- J V <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: LF, f , 14'1 cz., r r 4 GS Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: b7—.1 Y- 9 <br /> Reporting Agency Name: <br /> Address: C ) <br /> C. LOCATION AND DATE OF DI!� G J / <br /> Location: yj2�(' � J CC T'i s _ <br /> (Best Physical Description) / (City o County Circle one <br /> Date of Discharge: - <br /> Date Notified: 1 – L-- 9 7 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: / n <br /> Con[ac[ Person: T lephone: ( --) <br /> Physical Address: ri / ��1 C7f &.51—v GKsZllvr <br /> Mailing Address: C m <br /> E. DESCRIPTION <br /> Type of Discharge: Z 1QS, <br /> 1 ooSO—.Q- <br /> Volume: o <br /> Chemicals: <br /> Circumst ces: <br /> F. ACTION TAKEN # d,s� <br /> SITE ST' TUS <br /> as- <br /> EH 22 013 (Rev.4/91) _ <br /> JAN-14-1997 00:14 97% P.02 <br />