Laserfiche WebLink
' SAN JOAQUIN COUNTY <br /> p NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> 9 HE,.kLTH g SAFETY CODE 25180.7 <br /> EH LOG aa_ Q / <br /> A EMERGENCY LEVE 11 111 <br /> I rr le one) <br /> B. SOURCE OF INFORMATION <br /> I _Phone: fj <br /> Name: how_ (y�v,ro m <br /> Company: 5 { o <br /> Address: 8 Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> L� <br /> Location: O r �r County) Circle one <br /> (Best Physical Descri tion) <br /> Date of Discharge: t''') Time: <br /> Date Notified: b 3 <br /> D RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Ke—r r ( Phone: <br /> Contact Person: <br /> Phvsical Address . 2lr �1 t <br /> Mailing Address: <br /> E. DESCRIPTION 1 <br /> Type ofDischarae: r\ I l� �`euSe <br /> Volume: Ili r <br /> Chemicals: aor e »� P,tiJvrO <br /> Circumstances: <br /> ��a 1r <br /> srS <br /> F ACTION TAKEN � <br /> „u1 eI�?ase_ rwr <br /> SITE DISPOSITION ti0�1 S <br /> � � n <br /> n <br /> EH 22 013 (Rev.08/20/93) <br />