Laserfiche WebLink
• SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DI �,rL RG <br />F(C(0 [Py <br />HEALTH & SAFE'T'Y CODE 25180.7 <br />A. EMERGENCY LEVEL:0 II III <br />(Circle One) <br />B. SOURCE OF <br />Name:---� <br />PHS -EH LOG # <br />Phone: (1:Lj} 7 v7r07'- . <br />Company: <br />Address: Phone: <br />Designated Employee Name: <br />Reporting Agency Name: <br />C. LOCA'T'ION AND DATE OF DISCHARGE <br />(Best Physical Description) ' <br />Date of Discharge: 7 <br />Time: <br />Date Notified: <br />' �D <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: ^ <br />Contact Person: _ <br />Physical Address: <br />Mailing Address: <br />Lt � 7 7' r� <br />E. DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals: <br />Circumstances: <br />F. <br />SITE DISPOSITION <br />EH 22 013 (Rev -4/91) <br />