Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICA..JN OF HAZARDOUS WASTE DISC-.ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL--? I III PHS-EH LOG # � <br /> (OIrcle One) <br /> B. SOURCE OF INFO TION <br /> Name: ANAILK7'/G c i°� Phone: &!2, OrloZj <br /> Company: 0� <br /> Address: <br /> Designated Employee Name: G - Phone: Nan) tlbs 3L/ <br /> Reporting Agency-Name: <br /> Address: Wq 5 Af- -54.</ <br /> C. LOCATION A� DA OF DISCHARGE <br /> • <br /> Location• / 3 k <br /> (Best Physical Descri tion) / (1�r County) Circle One <br /> Date of Discharge: cv <br /> Date Notified: Time: 0 z) <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: _f��/dtda fn r,� <br /> Contact Person: ,r( /iAi Al - e� - Telephone: ( - <br /> Physical Address: --2� I_ Com,camel�,�. Atu-rA4AJc r�� /1/Z <br /> Mailing Address: 7 o 1644W Cv?1� .STT 1540 LA4J e/yZ 3 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: A�jf,rri e2F <br /> F. ACTION TAKEN jQ6 <br /> SITE DISPOSITION <br /> Ay / �ccs ?U � -r/ i fl�1. _- s <br /> EH 22 013 (Rev.4/91) <br />