Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> I <br /> A. EMERGENCY LEVEL: 0I II III PHS-EH LOG # g c2 q 7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �T�� ��T s Telephone: c(J�� ) —� <br /> Reporting Agency Name: J(2�do 4V-:' <br /> Agency Contact: /���;�/ 41-111�� Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Zle : <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: 2<:!� — Time: <br /> TJ. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person:�C6 _S� Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release:(Ve <br /> Chemicals: 1�� <br /> F. ACTI/ON TAKEN <br /> Ar) Plki w(tC <br /> EH 22 03 (Rev. 7/89) <br />