Laserfiche WebLink
SAN JOAQUIN COUNTY ` <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:© II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �t,�T'//'�/��gi�x'/l, �G!/m�i Telephone: j(��� ) 7�Z - 'z#0 <br /> Reporting Agency Name: <br /> Agency Contacts Telephone: (Z yi_SI <br /> Address: AW <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: _ �i/✓ /�o� <br /> Date Notified: <br /> Time: _ � •/'> <br /> D. RESPONSIBLE PERSONS SINESS <br /> Name of Business <br /> Contact Person: �jcl✓c,��� <br /> Telephone: <br /> 4,/I �!?&x /ate O y <br /> Address: . <br /> E. DESCRIPTION ® �-- <br /> Type Release: �i1��//�/i zee( e e4sy, fio� ,� �ro�nd ���� %✓��S <br /> Volume: a�✓ <br /> Chemicals: o���'� moi / vis• <br /> F. ACTION TAKEN <br /> _��r✓ P�rllonryl��7�/ 5�SS�'!�i'/1s /I�� .�-!� t'o.�cl��f' Gti 1/'�+�ie u5 �O/Isv%,1�.�� <br /> hl°5 /Jv�r� l/�u Ael4e6/ T f�� Z�/lo��� ✓ �� 7 r r/���i� <br /> rD/TT/l' S/r7�C 1�55�51/J/• �i�/ '/jam/ Gr/b//� �'�� )e <br /> EH 22 03 (Rev. 7/89) �' ��/r'�/i�4 e i���� j' fl' l X^ <br />