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UAR/PROP 65_PRE 2019
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231963
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
12/23/2019 2:52:33 PM
Creation date
11/7/2018 10:04:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0231963
PE
2361
FACILITY_ID
FA0006445
FACILITY_NAME
PG&E: Stockton Service Center
STREET_NUMBER
4040
STREET_NAME
WEST
STREET_TYPE
Ln
City
Stockton
Zip
95204
APN
117-020-01
CURRENT_STATUS
01
SITE_LOCATION
4040 West Ln
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
KBlackwell
Supplemental fields
FilePath
\MIGRATIONS\W\WEST\4040\PR0231963\UAR_PROP 65.PDF
Tags
EHD - Public
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j <br /> 00 SAS JOAQLLr COL-QTY V FILE COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG T <br /> (Circle one) <br /> B. SOURCE OF NFOR..IATION <br /> Name: Phone: ( ) <br /> Company: <br /> Address: C- <br /> Designated Employee Name: �eJ �`�'i`�t� B Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCI-LARGE <br /> Location: ��J �� 5 I .Qa22 �S��C�I 1 <br /> (Best Physical Description) Cr`Count<) Circle one <br /> iti` <br /> Date of Discharge: <br /> Date Notified:_ / = f% Time: -��nyv✓ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: ' ' SLI` Phone: <br /> Ph,.-sical Address: <br /> LN/tailing Address: G , — <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: n �t-v`►'�� <br /> Chemicals: <br /> Circumstances: <br /> a4 <br /> F. ACION TAKEN ' <br /> SITE DISPOS ON ' <br /> �r <br /> EH 22 013 (Rey. 08/20/98) <br />
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