Laserfiche WebLink
• SAN JOAQUEN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCW <br />HEALTH & SAFETY CODE 25180.7 ur CAny <br />A EMERGENCY LEVEL I II III PHS -EH LOG T 9q' <br />y <br />"cle one) <br />B. SOURCE OF INFORNIATION <br />Name: L o Phone: <br />Companv: <br />Address: 2 <br />Designated Emplovee dame: Phone: <br />Reporting Agency Name: Q[FS�(� <br />Address: 30LI. wfa� ma 5 za Z <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: 1-6 <br />(Best Physical Description) (Cit) or County) Circle one <br />Date of Discharge: ut,2KA)O%_-)A,? <br />Date Notified: � 1 q `t Time: <br />D. RESPONSIBLE PERSONBUSINESS <br />Name of Business: JoIA.,_�.T'CA.4 tolr f -�1L:s <br />Contact Person: <br />Physical Addre <br />ivlailing Addres <br />E. DESCRIPTION <br />Type of Discharge <br />o <br />Chemicals: 4- <br />• .. �• - • Y <br />F. ACTION TAKEN v57 's L•o,%A,. (,-u " rv�av�cn.�slc _ r�oveoP , Ta.n���� <br />SITE DISPOSITION <br />LJAL Q�- <br />Co%A:bo <br />EH 22 0 t3 (Rey. 03/20/93) <br />