Laserfiche WebLink
*Mope . <br /> SAN'JOAQUIN COUNTY. FILE c o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` PY <br /> 304 East Weber Avenue, P Floor, Stockton,CA 95202-2708 <br /> (209)468-3420•Fax:(209)464-0138• Web:www.co.san-joaquin.ca.us/ehd <br /> NOTIFICATION HeHASROUS WASTE <br /> DISCHARGE p CHARGE <br /> California HAZARDOUS <br /> EHD LOG#: <br /> A. EMERGENCYLEVEI� I 1 II <br /> l� (Circle One) <br /> B. SOURCE OF INFORIMATION Phone: em) 13 7 7y <br /> Name: Q LUIJ r Y (e L <br /> Company: MZ S ��nLVkvri Zip Code: <br /> 1 rlr N. �^1� city: <br /> Address: AA�, <br /> Designated Employee Name: A <br /> Reporting Agency Name: A e City: A tsv� Zip Code: <br /> Address: ' <br /> C. LOCATION AND DATE OF DISCHARGE 5 _ �Countyt <br /> Location: (Best Physical Descnpuon) <br /> (;5' <br /> �SL A Jl. <br /> Date of Discharge: <br /> Z� O Date Notified: 2 b Time: <br /> D. RESPONSIBLE PERSONIBUSIF ES Su� <br /> Name of Business: i Phone: (Zor) 9`�6ef <br /> �� QrN 1 R�1 Lav <br /> Contact Person: +� N �{vr (l City: SGV � Zip Code: <br /> Physical Address: City: —Zip Code:. <br /> Mailing Address: <br /> 1 <br /> E, DESCRIPTION <br /> Type of Discharge: CQNDD wUlr� <br /> Volume: <br /> P4 I - M e <br /> Chemicals: <br /> Circumstances: Il¢! 1- <br /> A <br /> F. ACTION TAKEN: <br /> SITE DISPOSITION: <br /> Notification of Haz DiX�` <br />