Laserfiche WebLink
SAN JOAQUIN COUNTY f, <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 " .`y, 4.04 04 <br /> A. EMERGENCY LEVEL: 11 III PHS-EH LOG # - D <br /> (C1rcle One) <br /> B. SOURCE OF INFORMATION 1 <br /> Name: w JJ Phone: Cz&j `v q�-7 <br /> Company: Groff <br /> Address: _ <br /> Designated Employee Name:? ! Phone: (t&) v <br /> Reporting.Agency Name: <br /> Address: ,f6/r �Gc,CnP1_1[ f Zu <br /> C. LOCATION AND DATE OF <br /> IDISCHARGE <br /> �7 <br /> Location:-�l DO� <br /> , <br /> (Bests Physical Description) r County) Circle One <br /> g <br /> Date of Discharge: a / <br /> Date Notified: - 4rl401crTime- - 3o <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: a <br /> Contact Person: Telephone: C1� 36 - 122, 4 <br /> Physical Address: 04L t /moo 0.4 t <br /> Mailing Address: Zp ..11'gA2-4'_---a4;&!42i...Y .� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: jLN 4:�,4Uw I <br /> Chemicals- 1 <br /> Circurristances:_�.4l:gr.rre4 DeZ6ret-iJ �EiQa�e.�F.a S�•lcG cv,�rr_ <br /> _ ►i�J.4Ti /. i.:.. <br /> r , <br /> F. ACTION TAKEN 710, <br /> ..., make t, <br /> Ar <br /> r . <br /> r .. <br /> : <br /> SITE DISPOSITION _. n' BE66. 7Z ar1tTr-4.�rrn1� ' <br /> .. ..:._ <br /> , <br /> Y� <br /> EH 22 013 (Rev.4/91) -= x 4 <br />