Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WAST my <br /> HEALTH & SAFETY CODE 28 <br /> A. EMERGENCY LEVEL:/ I II III PHS-EH LOG # / Cl — ! `� <br /> rcle One) <br /> B. SOURCE OF INFORM ION <br /> Name: rrrL Qil Phone: (9& 36 —f7o( <br /> Company' <br /> Address: 2)0-1 -7 V,+9 -. aP ';or (lgiS 3277 <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: yay� er b,' (+ / OVA(-eCa- <br /> (Best Physical Description) tty r County) Circle One <br /> Date of Discharge: ✓ (b` , <br /> Date Notified: jqqa, Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: CO-( X51 (CyK12� CZ4+rIs', <br /> Contact Person: , U� Ion Telephone: Zc7 i 5;Q —� <br /> Physical Address: W:53 <br /> GLV `� ff ^ 2�Z i 1�L v1i2 C bZ CA `1 S 3 <br /> Mailing Address: <br /> E. DESCRIPTION - � <br /> Type of Discharge: i Ao W —0-y n <br /> Volume: <br /> Chemicals: <br /> Circumstances: S,D6l (� _r l V1.�v�l h i i ',��. � Cx �" u�k (2uµGi C°-i N� J'J'L.✓Z�1 <br /> c4Ic�c� <br /> F. ACTION TAKEN <br /> SITE STATUS CL: ib ' O< :vl1u- <br /> <,�'ry� ,�� 2�t�vLt' � �znn it ��� �� �� P ( S � �tf1� i�� ( �w�✓sr�,Vit <br /> v <br /> T hls s1crfi�m b En -rS i'vv0JJ rlavo A�V, -loavi ci E v" �6t .G?5 cZ vi aft Cy�t dY, <br /> EH 22 013 (Rev.4/91) <br />