Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> NOTIFICATIONOND& SOUS WASTE <br /> S DI CHARGE <br /> FILE COPY <br /> PHS-EH LOG O�� <br /> A. EMERGENCY LEVEL: III <br /> (Circle One) <br /> B. SOURCE OF INFORMATIODN <br /> Phone: 209 <br /> Name. u6/« l -moo <br /> Company: ATG <br /> P6oir 9 Phone: <br /> Address: <br /> Designated Employe Name rou 6/� lie G v c <br /> Reporting Agency Name: � T C-f <br /> Address: 3o v E• w 6-11 A <br /> C. LOCATION AND DATE OF D[SCHARG5 �LiG / <br /> � (City o <br /> Location: & 73.-.2- r�w Co � Circle One <br /> (Best Physical D cripdon) <br /> �" g: .4� <br /> Date of Discharge= ' Time: J <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS ns <br /> Name of Business: /( _ J a z� ` G• Z� Te ephone: <br /> Contact Person: 7 9 <br /> Physical Address: ;. <br /> Mailing Address: r <br /> E. DESCRIPTION <br /> Type of Discharge: h <br /> volume: <br /> Chemicals: v , n <br /> Circumstances: A Ovm r ec e�- <br /> F. ACTION TAKEN _ h - <br /> SITE STATUS <br /> NY? <br /> EH 22 013 (Rev.4/91) <br />