Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE '/ <br /> HEALTH & SAcETY CODE 25180.7 <br /> A. <br /> EMERGENCY LEVEL:�)II III PHS-EH LOG # C �� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION _ Yyr <br /> Phone: ( <br /> Nam <br /> Company: r <br /> Address: <br /> Designated Employee Name: Phone: z c <br /> Reporting A ency Name: a•� ev <br /> Address: PO• �CX <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: IL')Il WSJ ,rezl �fi <br /> (Best Physical Description) (City rCa run Circle One <br /> Date of Discharge: Z- <br /> Date Notified: S' z �^t- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: + ` <br /> Contact Person: Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: ��f <br /> F. ACTION TAKEN-5r� � <br /> a <br /> SITE DISPOSITION U- 'tz o <br /> i <br /> EH 22 013 (Rev.4/91) <br />