Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: d) II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: c c� `� �_``.Y c �. Phone: �) <br /> Company: \��« . % , <br /> Address: &3E, <br /> Designated Employe Name: Phone: 4(c n-C35Z- <br /> Reporting AgencyName: <br /> Address: 3e-4 - 'v0cebcr <br /> C. LOCATION ANDD TE OF DISCHARGE <br /> Location: C' 3' T-, <br /> (Best Phys cal Description) City r County) Circle One <br /> Date of Discharge: <br /> Date Notified: A- -� N Time: J� n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: Z.CO <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: ( �-� U« -�' ✓► �5 - c x eco - cz.e�� <br /> Volume: 2 c ( r <br /> Chemicals: e <br /> Circumstances: lb "f <br /> F. ACTION TAKEN <br /> t vn v <br /> SITE STATUS <br /> EH 22 013 (Rev-4/91) <br />