Laserfiche WebLink
00i 00� <br /> u SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 0 <br /> A. EMERGENCY LEVELI III PHS-EH LOG <br /> : I 1 % <br /> (Circle One) " <br /> B. SOURCE OF INFORMATION <br /> Name: S_Kl Lt, I 't 1,y r L2!��10-s Phone: (~��� <br /> Company: <br /> Address: ' <br /> f07� <br /> .� - - ;?o. -7� � �xn 6c.,.-,/CA 953 zf <br /> Designated Employee Name: , 7 ' <br /> Li'l <br /> �°fir`�� ��� i ���� Phone: U4) <br /> Reporting Agency Name: � ~ <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 &f!,6 6&4664,)C _ / S-k)C- <br /> (Best Physical Description) (City o ounty) ircle One <br /> Date of Discharge: <br /> Date Notified: /1-11 .. _ Time:D. RESPONSIBLE RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: fil; 0c,G 3c a <br /> . Contact Person: Telephone: <br /> Physical Address: y D/ ---._ ___,._,----------.._..-- <br /> Mailing Address: C 5 <br /> E. DESCRIPTION <br /> Type of Discharge: _i l�nczcG�Cs, �! <br /> Volume: <br /> Chemicals: C� , U I <br /> Circumstances: 2z es ' S <br /> F. ACTION TAKEN <br /> SITE STATUS // L <br /> \\: �? Jam"'.t 'J•/ �/ •e i' 'j� \-' ^� �Z �� � i .�--��/i / <br /> � % t 'i✓ 7 { ., 7 Lxr Y <br /> • L' <br /> EH 22 013 (R.ev.4/91) <br />