Laserfiche WebLink
\ SAN JOAQUIN COUNTY <br /> N NOTIFICATION OF HAZARDOUS WASTE DISCHARGE moi / <br /> HEALTH & SAFETY CODE 25180.7 Utz 1 �' <br /> A. EMERGENCY LEVEL: a0II III PHS-EH LOG # 3 <br /> (Circle One) <br /> B . SOURCE OF INFORMATIO <br /> Nam e: i /' i(T7 S Phone: - 3 /0 <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: b� ) /fi <br /> Reporting Agency Name <br /> Address: <br /> Co LOCATION AND DATE .OF DISCHARGE <br /> Location: A /� �C/� '� A o-ef / e�� <br /> (Best Physical Description) (Ci r County) Circle One <br /> Date of Discharge: cz= <br /> Date Notified: Time: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business : rl fz S CAR lAw os- <br /> Contact <br /> Contact Person: _ Er Telephone: (2aD a 715'- �5/ <br /> Physical Address: aG O <br /> Mailing Address : 5 � <br /> E. DESCRIPTION <br /> Type of Discharge: n i 1 <br /> Volume 1 <br /> Chemicals * Si <br /> Circumst ces • l'. a AO <br /> F. ACTION TAKEN 777 n <br /> - <br /> 40�7,11 <br /> r> i - <br /> / J <br /> SEEF.DISPOSITIONN. <br /> n <br /> a <br /> G A <br /> EH 22 013 (Rev.4/91 ) <br />