Laserfiche WebLink
SAN JOAQUIN COUPrrY <br /> 4 NOTIFICA'i.-__,N OF HAZARDOUS WASTE DISCI,.. AGE <br /> .` HEALTH & SAFETY CODE 25180.7 <br /> C(ap <br /> ®® r� <br /> A. EMERGENCY LEVEL: I II III - PHS-EH LOG <br /> Circle One <br /> B. -SOURCE.OF INFORMATION.. , `'�ti�u►N�, C, +�r�- <br /> Name: s�► u an Per �. g.s.�c�,t� phone: C20-7 <br /> Company: P <br /> Address: q 5 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name:_;., <br /> Address: <br /> ame: - - <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE _ b <br /> Location• ' C . s : / . LOQ <br /> •(Best Physical Description) . . rty r County) Circle One <br /> Date of Discharge: . _' <br /> IInkoll Date Notified: Time: 3' 3v <br /> D. RESPONSIBLE PERSON/BUSINESS' ` <br /> Name of Business: <br /> Contact Person: f=vy= Sv : Telephone: (� <br /> Physical Address: 2n= C <br /> Mailing Address: 4� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: r' <br /> Circumstances: <br /> F. ACTION TAKE itgs w_ 6 w <br /> i . <br /> SITE DISPOSITION <br /> s ►3 <br /> EH 22 013 (Rev.4/91) <br />