Laserfiche WebLink
V SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: } Telephone: ,?v% 1/(-/,J <br /> Reporting Agency Name: <br /> Agency Contact: �sl.X2/ De Telephone: <br /> Address: /610/ f . L-/a -Ive . <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: yam N . <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: / v��- <br /> Date Notified; Time: <br /> D. RESPONSIBLE PERSON/13USINESS <br /> Name of Business <br /> Contact Person: - ,J�{,.r�r/ Telephone: Ll <br /> Physical Address: , G/n <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: .� <br /> Chemicals: <br /> F. ACTION TAKEN <br /> SSQic ��Grfrs rev atl�GG� orf „C c i7 !rii7i:74' 'Un <br /> EH 22 03 (Rev. 7/89) <br />