Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICA'T'ION OF HAZARDOUS WASTE DISC GE <br /> HEALTH & SAFETY CODE 251;80.7 w <br /> I <br /> I i ' <br /> A. EMERGENCY LEVE L• I II III PHS-EH <br /> LOG <br /> cle One) I 'k <br /> 'i <br /> B. SOURCE OF INFORMATION 7 <br /> Name: <br /> Company: o is Phone: <br /> Address: D ar . C,4 <br /> Designated Employee Name: Uirr1 0 :Ij Ptone: <br /> Reporting Agency Name: <br /> E Address: <br /> C. LOCATION AND DAT OF DISCHARGE <br /> Location:_ /-Z'/E> W • (,lJ <br /> {Best Physical Description} (City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 8 lqj Time: !1: ; /, <br /> D. RESPONSIBLE PERSON/B INESS <br /> Name of Business: . aln k <br /> Contact Person: Ui f.?JSJ II` Telephone: CL�5f <br /> Physical Address: qj iI <br /> Mailing Address:_ _ /)x J//0 ` C' `�a�.II' C_.9 <br /> E. DESCRIPTION <br /> Type of Discharge: lieCt e— <br /> Volume: <br /> Chemicals: A 'C ` <br /> 96.4 <br /> ircurnstances: e v <br /> k <br /> F. ACTION TAKEN <br /> k <br /> II. III. <br /> SITE DISPOSITION 5r rrr Aria,, r" <br /> U 417- <br /> i� II <br /> it I� <br /> EH 22 013 (Rev.4/91) <br /> II <br />