Laserfiche WebLink
r�I <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE(DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I 11 111 PHS-EH LOG # <br /> Circle One) <br /> 13. SOURCE OF INFORMATION <br /> Original Source: , A jr.. Telephone: <br /> Reporting Agency Na e: lC <br /> Agency Contact: Telephone: —2/2 0 <br /> Address: Ala L „ l <br /> C. LOCATION AND DATE OF DISCHARGE / <br /> Location: 1?// E- LlafzlLtit-z <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: � , �o <br /> Date Notified: ��L$ Cj Time: <br /> 1). RESPONSIBLE PERSON/BUSINESS <br /> Name of Business AV(140 <br /> Contact Person: t.:�Ld-jAL(5-- Telephone: <br /> Physical Address: 2YO O&Aw)"I de Rd j ���� c ��-- <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: l �� <br /> I'. ACTION TAKEN <br /> s 4 Gc k /� /)L1/"� �� UJB c (l t�i'Z✓J�t( r�:. �F- "� � !i/� ( �JD(�. C7- <br /> • r'Prt' r�� `�7}=�1./I(1 rl��c..0 `t�,I17 o i :t.(,�.Q�-� , � �Ut.��c=-•L <br /> 1 <br /> F1 22 013 (Rev. 02/90) <br />