Laserfiche WebLink
SANJOAQUINCOUNTY <br /> = 2 ENVIRONMENTAL HEALTH DEPARTMENT 9 <br /> t 304 East Weber Avenue,3 d Floor, Stockton,CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138 . Web:www.co.san-joaquinxa.us/ehd <br /> 9C/FORS <br /> OTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> h California Health & Safety Code,Section 25180.7 <br /> EHD LOG#: O y <br /> O <br /> A. EMERGENCY LEVEL: Ib II III <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Phone: ( <br /> Name: n )c1�3-��'J7 <br /> Company: S/E ' <br /> Address: 3?S W NkZELfoh) Ade- City: e7 -rc"J Zip Code: 'K�l _ <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> City: Zip Code: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> �jfo�(c?D� / City County <br /> Location: �7� W E�� �T Circle One) <br /> (Best Physical Descnption) <br /> Date of Discharge: UNK Date Notified: /D ! O Time:' 103v <br /> p.� P.N. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: SIERRA W rat g F2. Wt'4[TCtR� <br /> Contact Person: &B LDA1Ef� -�FeqsPg Ac6ee— <br /> Phone: ` tf -7777 <br /> �? [�• �� '=r�' l City: otoT�^ Zip Code: <br /> Physical Address: `jl' X03 <br /> _City: Zip Code: <br /> Mailing Address: � <br /> E. DESCRIPTION <br /> Type of Discharge: L <br /> Volume: <br /> Chemicals: <br /> A/ <br /> Circumstances: <br /> F. ACTION TAKEN: Q w S <br /> C-01 u <br /> SITE DISPOSITION: <br /> w � <br /> Notification of Fin. <br /> EHD 22-02-003 <br /> .nnnnnx <br />