Laserfiche WebLink
6 SAN JOAQUIN COUNTY 0 (/ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> --� [A. EMERGENCY LEVEL: I II III ( P LOG # <br /> ( cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Mn++ Bromley _ Phone: (moo) q (A5S <br /> Company: The loam (orosl7 -- _ <br /> Address: 2,qg'U $uskUrK Je- Su,4-e- 12a pLQO-,c 1Y Fill 441523 <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: W) I uvrne.l'' <br /> (Best Physical Description) TFor County) Circle One <br /> Date of Discharge: nC VIJ- <br /> Date Notified: 12. 10. 9 Z Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 1 aflya- <fig I <br /> Contact Person: b N+UA -✓ Telephone: .2o9 <br /> Physical Address: 110 W +--r ovnct' Uai Cit Z — Oq 317 <br /> Mailing Address: PU Bc»c q39 f CA g62-U OL/ <br /> E. DESCRIPTION <br /> Type of Discharge: Leq <br /> Volume: U Acw vl <br /> Chemicals: pCh^oleL,m Coaso(w , <br /> Circumstances: kePDel r-eVi(!OJ <br /> F. ACTION TAKEN O dOjurOJVIJ elflU (Co(4e v <br /> SITF DISPOSITION 5tK l M rv2c cw) <br /> wd v- T1"lz- <br /> repKakaNtl, OL ALILUMLL421- <br /> EH 22 013 (Rev.4/91) <br />