Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: OII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: E. /y)CG'o LL e tql, Phone: o�) <br /> Company: <br /> Address: mob F L.,veoG.y ,jc. s Jos E, <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: - - - 16,-1 /4<M `ou�e,r TOcx.TOA/ _ <br /> (Best Physical Description) ity r County) Circle One <br /> Date of Discharge: UN/C <br /> Date Notified: 6 .2 7-T/ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: L��veoG,✓ /'�Pc-�r;Es �o, <br /> Contact Person: k,4=e&V 14JA 1 ✓ii _ Telephone: ( -�V•Zzoo X<17 <br /> Physical Address: /o/ <,.vice �, <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: ON K <br /> Volume: C)NX <br /> Chemicals: �9C'Ero NE Lac D� r- <br /> Circumstances: /%a-4-t-z Q� "(o-t <br /> F. ACTION TAKEN <br /> SITE DISPOSITION (!f4 , / <br /> l <br /> I. -TI22 013 (Rev.4/91) <br />