Laserfiche WebLink
SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG # <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: �.Zuj// ,4%GffL/0„,41,7/iTelephone : <br />Reporting Agency Name: „. iY�Or%l�G!!i✓ LoG�G /,��acr/f <br />Agency Contact: , �Ni�yely Telephone: <br />Address: A ®, OOX .2-�G �/. S-7ad T®/✓, C -A- <br />C. LOCATION AND DATE OF DISCHARGE / <br />Location: A flj-rA� &�.r�/N e�- / V %o6y G1 lfrZ� <br />(.Best Ph�y/sical escription) (City or County) <br />Date of Discharge: y! 160VAIAII <br />Date Notified: f-- f3 — Il'l Time: <br />D. RESPONSIBLE PERSON/B��UrrS/INESS <br />Name of Business C../��-- <br />VRZOAV fVZ7/!ycal l <br />Contact Person: <br />`J FFA Telephone: <br />Physical Address: o��®s 1-1�*J-a"114100/;-.// '% <br />E. DESCRIPTION <br />Type Release: (/r✓ /��t Ti�U2/ Z �I' /"ell SG <br />Volume: ivmle I awl <br />Chemicals: <br />F. ACTION TAKE <br />Q S re -,q <br />V <br />N <br />be mqu nce,,l -a <br />& vtd .e-, <br />m P 4t. -le, a-gGfk Cy . <br />r`f Tf1 <br />