Laserfiche WebLink
FILE COPY <br /> 4&*INOTIFICATION <br /> SAN JOA0UIN COUNTY <br /> OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III EH LOG# <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: v�� � Phone:4 6) 61�'" Ubb <br /> Company: <br /> Address: <br /> Phone: b �, 4� `s <br /> Designated Employee Name: �c �� <br /> Reporting Agency Name: %J OVA <br /> Address: 264 E7, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> sir w . Vokte,M� `��' . I LeDi C4, <br /> (Best Physical scription} ;ty r County) Circle one <br /> D <br /> Date of Discharge: N lltol <br /> Date Notified: D d2 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: AfLw 8P <br /> Contact Person: L►+-� l.r` Phone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION n <br /> Type of Discharge: <br /> Volume: ►-' <br /> Chemicals: <br /> Circumstances: '$ <br /> F. ACTION TAKEN � r53 h <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.08/20/98) <br />