Laserfiche WebLink
0 SAN JOAQUIN COUNTY <br /> NOTIFICATION HAZARDOUS <br /> SARD DCHARGE <br /> HEALH OE 280.7 FILE C0PY <br /> n l�5'O i a <br /> A. EMERGENCY LEVE L:% !J It III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION Phone: <br /> Name: <br /> Company: .L /.,oa. ✓A 9�l0 <br /> Address: //01-0SOrVC /TE� ✓�'e "�,' phone. (_J <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION ANQ DATE OF DISCHARGE <br /> Location: 67"3-7 w �Iww6W- / <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: it/,CA100 ✓ <br /> Date Notified: _ O5 Time: ��'� <br /> D. RESPONSIBLE PERSON/BUSINESS x/083 <br /> Name of Business: WET Telephone: <br /> Contact Person: --916! A 40z --���� / <br /> Physical Address: <br /> Mailing Address: ----- <br /> E. DESCRIPTIONy N X-N o uJ�t/ <br /> Type of Discharge. -- <br /> Volume: /J,y�ou/N'� <br /> Chemicals: <br /> Circumstances: o�7Y - OXO <br /> F. ACTION�T /AKEN — UOQ` ' ZW <br /> SITE DISPOSITION_ <br /> EH 22 013 (Rev.4/91) <br />