Laserfiche WebLink
o <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG <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 /> Name: Ke oevr Vc A Phone: <br /> Company: <br /> Address: 73 0;.1 r .a 4, 4 4�/SS— <br /> Designated Employee Name: : Phone: <br /> Reporting Agency Name: (G, Hs -F- 40 <br /> Address: 41} S 4F - <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 16500 4©v/st <br /> (Best Physical Description) or Countyj Circle One <br /> Date of Discharge: Un /(- <br /> Date Notified: ;?-5-- <i Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: g P n;( C <br /> Contact Person: <otf /- /-O, Telephone: (�} <br /> Physical Address: /byC0 S.� P,-r .t-�Av '5o( _ i /mow r -%+ .. XV80 <br /> Mailing Address: S r <br /> E. DESCRIPTION <br /> Type of Discharge: 14,�,j T o rr z e- 7- <br /> Volume:Volume• <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN /,2-/o— <br /> �.YY✓ W,9,11 Ai,4Ka VW h&4 <br /> SITE DISPOSITION_, /`_ 121,vc7� ' eS4 on <br /> EH 22 013 (Rev.4/91) <br />