Laserfiche WebLink
i <br /> � 4 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE D'S <br /> C'rL'RGE <br /> HEALTH & SAF HTY CODE 25180.7 <br /> EMERGENCY LEVEL: pI It III <br /> PHS-EH LOG # <br /> (Circle One) <br /> SOURCE OF INFORMATION Phone: (Z�`ll 5?2- 0900 <br /> Name: 'Donno, AIItIU <br /> Company: Anal 4}bc <br /> Addaf Cabana Irn yes <br /> Comc <br /> d-i✓ .,.c � � hCDda�fD CA <br /> ress 031 1•(0.15615 Phone (_) — <br /> Designated Etnoloyee Name: <br /> Reporting Agency Name: <br /> Address: <br /> LOCATION AND DATE OF DISCHARGE / .DC. y' <br /> Location: 1�0I W. V 6htn� <br /> (Best Physical Descnpnon) (Ci r County) Circle One <br /> Date of Discharge: uiYllLYL61^�n Time: <br /> Date Notified: �� <br /> RESPONSIBLE re- <br /> O02 12M <br /> E <br /> / US[DE f� <br /> Name of Business: Telephone: r� y�g Z� <br /> Contact Person: �� D c9*VY) 962 Z <br /> Physical Address: C t <br /> Mailing Address: <br /> E, DESCRIPTION n. K <br /> Type of Discharge: •C�� <br /> Volume: U� K <br /> Chemicals: <br /> m <br /> Circustances: 2 ° ^ n <br /> ACTION TAKEN �� <br /> - �L.Y�✓/liVVi4.J� ✓J�irT../,,n .% �w��n2^�P . <br /> W iYh U <br /> SITE DISPOSITION T 6i <br /> aY F E .� Ov- <br /> n <br /> W Gg <br /> X <br /> EH 22 013 (Rev-4/91) <br />