Laserfiche WebLink
SAN JOAQUIN COUNTY Y <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELD II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION' <br /> Original Source: �..e.�I t D�- <br /> i �- Rescue Telephone: 00 <br /> Reporting Agency Name: `-' <br /> Agency Contact: Telephone: <br /> 0jAddress: <br /> C. LOCATION AND DATE OF DISCHARGE ' F <br /> Location: <br /> (Best Physical Description) (City or County) <br /> , r <br /> Date of Discharge: <br /> Date Notified: Z Time: <br /> D. RESPONSIBLE PE SO /BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: <br /> Physical Address: E Com— LVIe44 -S 5 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 71 <br /> J <br /> � r <br /> EH 22 03 ( ev. 7189) _ <br />