Laserfiche WebLink
SAN JOAQUIN <br /> COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTI-I & SAFETY CODE 25180.7 <br /> A. EMERGENC LEVEL: I II III <br /> (Circle One) PHS-EH LOG # q <br /> B. SOURCE OF INFORMATION <br /> Original Source -;A. <br /> Telephone: <br /> Reporting Agency Name: JLe ff S <br /> Agency Contact: '�&Dy�, Telephone: a0 — a <br /> (�) -� D <br /> Address: p0 O <br /> C. LOCATION D DATE OF DISCHARGE <br /> Location: <br /> (Best Fhysical Desc ption) (City or County <br /> Date of Discharge: <br /> Date Notified: a a 7 <br /> Time: <br /> D. RESPONSIBLE ' -RSON/BUSINESS <br /> Name of Busines <br /> Contact Person: v <br /> Telephone: <br /> Physical Address: 3 a <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: S <br /> F. ACTION TAKEN <br /> a7 s G <br /> az <br /> / x <br /> EH 22 03 (Rev. 7/89) <br />