Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 6)II III rELOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION / �c� <br /> Name: 411- co Phone: Com/ <br /> 717 <br /> Company: u+ <br /> Address: 9 ' <br /> Af o.✓� i 14 o ' '- A 6 <br /> Designated Employee Name: `� Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: //3() 2-a— / <br /> (Best Physical Description) (Ci or County) Circle One <br /> Date of Discharge: <br /> Date Notified: 12-5 -191 Time: /o: 0 a— <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ✓�-``-"-�-�-�-� GGA <br /> Contact Person: telephone: 3 <br /> Physical Address: <br /> Mailing Address: 3/.5Fu�, <br /> E. DESCRIPTION <br /> Type of Discharge: 5 <br /> Volume: <br /> Chemicals: <br /> - <br /> Circumstances: <br /> F. ACTION TAKEN <br /> GcJ..c,e-cv c <br /> SITE DISPOSITION u� 4 <br /> � ,a•� cLo <br /> EH 22 013 (Rev.4/91) <br />