Laserfiche WebLink
° SAN JOAQUIN COUNTY . FC , .. <br /> NOTIFICATION OF HAZkFZCUS WASI'E DIS�.ARGE �. - .< <br /> HEAL,7rI & SAF-c:IY,CODE 25180.7 -' <br /> A EMERGENCY LEVEL. 0II III PHS-cH LOG <br /> =�0 <br /> ' :. i� �. <br /> (Circle one) i F °{y ,A a _. <br /> Ur <br /> 3. SOURCE OF INFORIMATION <br /> '► Phone: - <br /> Name: �) <br /> Company: <br /> Address• Phone:I, ) <br /> Designated Empicyee Name: !�, <br /> Reporting ASency NaMe: <br /> Address: <br /> 4:10 Al- 5A.( s�A .. . <br /> ,3 = <br /> C. LOCATION AND DATA OF DISCHARGE GnT' <br /> Location• 2 ly�.�FFo r County) Circle One <br /> .(Best Physical Oescziotion) <br /> Date of Oiscitiarge: <br /> Date Ncdfed: raze•: <br /> ,. <br /> D. RESPONSMUE ?EMON/gUSMESS <br /> Name of Business Y— �GD.r <br /> Canrac: Pe:saa: Jd � Telephone: LzS <br /> �' Q . G DIC. Zz ; <br /> Physical Address: 5 (o /�v I--? 5220 <br /> MazZ2ng Address: <br /> S. DESGR.IPTICN `- _ . <br /> Type of Disctzar;e: =i Z r-- <br /> UA lC�Jaw PJt y � <br /> Chemicals: __521-S aL--=A)E <br /> C:rC'=Stances: �rL ��vL? f=,e1Y�� <br /> Cc r , =iJ T'F'ai I <br /> �. A= N T v 6£ 1C �i S , �G.Lr �=f^. <br /> 7 /6 l <br /> i, <br /> DIS�OSi T ION � S� � �' ,r � <br /> - <br /> % Ze-A'12101 <br /> 1 <br /> + Ir <br /> E:: 22 013 CRXI.4/4i) _ ` <br />