Laserfiche WebLink
- y <br />r.. <br />SAN JOAQUIN COUNTY t <br />NOTIFICA'T'ION OF HAZARDOUS WASTE DISCHARGE . <br />HEALTH & SAFETY CODE 25180.7 <br />A. <br />C. <br />Q <br />E <br />EMERGENCY LEVEL:pkrcle <br />II tit <br />( One) <br />SOURCE OF INFORMATION <br />Name: I -tjd(S ";^ct r k -(z - <br />Company:. _yrl {fir 00-A4- <br />Address: <br />td Address: 1-1(p :3q- 7h S't_ <br />Designated Employee Name: <br />Reporting Agency Name: <br />Address: <br />LOCATION AND DATE OF DISCHAP <br />Location:Sari <br />(Best Physical Description) <br />Date of Discharge: <br />Date Notified: - Z <br />RESPONSIBLE P <br />Name of Busine: <br />Contact Person: <br />Physical Address <br />Mailing Address: <br />s <br />DESCRIPTION }' <br />Type of Discharge: L j:Lk- <br />Volume: <br />Chemicals: <br />Circumstances: W v- e zvL� <br />c1no <br />r <br />' PHS -EH LOG #__�j � <br />&!;�-r County) Circle One ' <br />LID <br />LF1 22 013 (Rev.4/91) <br />