Laserfiche WebLink
oP SAN JOAQUIN COUNTYR. <br /> -- <br /> Q;:.<;� ENVIRONMENTAL HEALTH DEPAR'i HENT <br /> 600 East Main Street Stockton • CA 95202-3029 <br /> (209)468-3420•Fax.(209)464-0138 • Web:www.sipov.org/ehd t <br /> C (ar <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> A. EMERGENCY LEVEL IMIJI 1 " IEHD LOG# <br /> B. SOURCE OF INFORMATION p <br /> NAME: I PHONE: <br /> COMPANY: CITY: <br /> ADDRESS. QO/ !DU <br /> DESIGNATED EMPLOYEE NAME: PHONE: <br /> REPORTING AGENCY NAME: <br /> ADDRESS: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LOCATION: �Q S Q,tn.�, CITY,, �� Inco rated <br /> Best Physical Description <br /> Unincorporated <br /> orated <br /> DATE OF DISCHARGE: UM "W, <br /> DATE NOTIFIED: 101A.47011TIME: ID'Otf-4A- , <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> NAME OF BUSINESS: AAd' <br /> CONTACT PERSON: PHONE: <br /> PHYSICAL ADDRESS: U/Vo J <br /> MAILING ADDRESS: 4.S 07 <br /> E. DESCRIPTION <br /> TYPE OF DISCHARGE: <br /> VOLUME: <br /> CHEMICALS: H_cl <br /> -�0 <br /> CIRCUMSTANCES: <br /> F. ACTION TAKEN <br /> c ort rm4�,te <br /> cl` Y&u- ZZ W/ o <br /> SITE DISPOSITION <br /> L/1&-*� A-e-9 -A - <br /> w P�oP_ to�. / <br /> ER RECORD MODIFIED Revised 05/01/2007 <br />