Laserfiche WebLink
SAN JOAQU N COUNTY FILE COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFE'T'Y CODE 25180.7 <br /> A. EMERGENCY LEVE1 II III PHS-EH LOG T <br /> rcle one) <br /> B. SOURCE OF INFORMATION <br /> Mame: Phone: ( ? <br /> Company: vn <br /> Address: <br /> Designated Employee Name: Phare: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION ,,VND DATE OF DISCHARGE <br /> Location: ' <br /> (Best Physical Description) (City or County) Circle one <br /> Date of Discharge: "' U Time. !Z c re <br /> Dale Notified: 1 D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: ' �G Phone: Z C <br /> Concact Person: �hC '' )�� <br /> phvsical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: 1; ` <br /> Volume: <br /> Chemicals: � <br /> Circumstances: <br /> F. ACTION TAKEN <br /> T- <br /> SITE DISPOSITION <br /> r' � ;,••�: it <br /> h • <br /> 1 <br /> EH 22 013 (Rev. O&T/93),1 � <br />