Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> 4�X <br /> HEALTH & SAFETY CODE 25180.7 <br /> EMERGENCY LEVEL: I II t 01 )PHS-EH LOG# <br /> rcle one <br /> B. SOURCE OF INFORMATION Q <br /> Name: -co t"4�� K�Gdtvza Phone: ( ) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /DOp E. /6d. /' 4c / ZQ�lyc�� <br /> (Best Physical Description) (City or County) Circle one <br /> Date of Discharge: 5--/2 0 <br /> Date Notified: Time: AK�- <br /> 1 -0 <br /> D. RESPONSIBLE PERSON/BUSINESS n <br /> Name of Business: 0� . <br /> Contact Person-&.fes Phon�.�oy 7V2- <br /> -5275 <br /> Physical Address: <br /> 51A- <br /> Mailing Address: S ,d <br /> E. DESCRIPTION <br /> Type of Dischar e: 6.614 /Pat <br /> Volume: 2 <br /> Chemicals: 4A—k r&4-0— <br /> Circumstances: Jt <br /> 651Ecam►.fi # <br /> F. ACTION TAKEN U.10. /l'K�t- C c 'o►.�S a.o <br /> SITE DISPOSITION 4,co' <br /> _ f �✓fi+�e <br /> EH 22 013 (Rev. 08/20/98) <br />