Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 0 • _ <br /> �. EMERGENCY LEVEL: �111 III PHS-EH LOG # <br /> ( trcle One) <br /> r3. SOURCE OF INFORMATION <br /> Name: Phone: (. ) <br /> Company: <br /> Address: <br /> Designated Employee Name:�ja Tu rkA++-e, _ Phone: <br /> Reporting Agency Name: S - <br /> Address: PO 1;Q7a 9g� S� Lid• Of SZU( —0 3 <br /> LOCATION ANDATE OF DISC E <br /> Location: V 92 N & l W <br /> (Best Physical Description) (City o County) ircle One <br /> Date of Discharge: i,utpl�U14D n <br /> Date Notified: qto Time: (o.o Q <br /> ?. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> I <br /> Contact Person: Ut/l Ir Telephone: <br /> Physical Address: l3 Q �i N • tie �J, t-Z Cf 15.2q-0 <br /> Mailing Address: <br /> DESCRIPTION <br /> Type of Discharge: k(l 21^ <br /> Volume: LA A Sly n <br /> Chemicals: cl nn <br /> Circumstances: S <br /> F. ACTION TAKEN (l rlS CA -z SeA WIA (ZYIC.(e L4A(T <br /> SITE STATUS S r�in4u,t0 <br /> so. e rn <br /> 1(-5 TS o -�,��a L.e,V rl c a n S-�a -u S hA <br /> EH 22 013 (Rev. /91) <br />